PRIOR PRINTER'S NOS. 398, 955, 969, PRINTER'S NO. 1076 1040, 1045
No. 387 Session of 2003
INTRODUCED BY M. WHITE, MOWERY, WENGER, KUKOVICH, PILEGGI, DENT, LAVALLE, MUSTO, ERICKSON, PUNT, CORMAN, SCHWARTZ, GREENLEAF, RAFFERTY, ORIE, KASUNIC, PICCOLA, TARTAGLIONE, MADIGAN, STACK, WONDERLING, WOZNIAK, RHOADES, THOMPSON AND BOSCOLA, MARCH 3, 2003
SENATE AMENDMENTS TO HOUSE AMENDMENTS, JULY 8, 2003
AN ACT
1 Reenacting and amending the act of July 8, 1986 (P.L.408,
2 No.89), entitled, as reenacted and amended, "An act providing
3 for the creation of the Health Care Cost Containment Council,
4 for its powers and duties, for health care cost containment
5 through the collection and dissemination of data, for public
6 accountability of health care costs and for health care for
7 the indigent; and making an appropriation," further providing
8 for the Health Care Cost Containment Council, for powers and
9 duties of the council, for data submission and collection,
10 for data dissemination, for mandated health benefits, for
11 access to council data, for enforcement and penalty and for
12 expiration; and providing for penalties. <--
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. The title and sections 1, 2 and 3 of the act of
16 July 8, 1986 (P.L.408, No.89), known as the Health Care Cost
17 Containment Act, reenacted and amended June 28, 1993 (P.L.146,
18 No.34), are reenacted to read:
19 AN ACT
20 Providing for the creation of the Health Care Cost Containment
21 Council, for its powers and duties, for health care cost
1 containment through the collection and dissemination of data, 2 for public accountability of health care costs and for health 3 care for the indigent; and making an appropriation. 4 Section 1. Short title. 5 This act shall be known and may be cited as the Health Care 6 Cost Containment Act. 7 Section 2. Legislative finding and declaration. 8 The General Assembly finds that there exists in this 9 Commonwealth a major crisis because of the continuing escalation 10 of costs for health care services. Because of the continuing 11 escalation of costs, an increasingly large number of 12 Pennsylvania citizens have severely limited access to 13 appropriate and timely health care. Increasing costs are also 14 undermining the quality of health care services currently being 15 provided. Further, the continuing escalation is negatively 16 affecting the economy of this Commonwealth, is restricting new 17 economic growth and is impeding the creation of new job 18 opportunities in this Commonwealth. 19 The continuing escalation of health care costs is 20 attributable to a number of interrelated causes, including: 21 (1) Inefficiency in the present configuration of health 22 care service systems and in their operation. 23 (2) The present system of health care cost payments by 24 third parties. 25 (3) The increasing burden of indigent care which 26 encourages cost shifting. 27 (4) The absence of a concentrated and continuous effort 28 in all segments of the health care industry to contain health 29 care costs. 30 Therefore, it is hereby declared to be the policy of the 20030S0387B1076 - 2 -
1 Commonwealth of Pennsylvania to promote health care cost 2 containment and to identify appropriate utilization practices by 3 creating an independent council to be known as the Health Care 4 Cost Containment Council. 5 It is the purpose of this legislation to promote the public 6 interest by encouraging the development of competitive health 7 care services in which health care costs are contained and to 8 assure that all citizens have reasonable access to quality 9 health care. 10 It is further the intent of this act to facilitate the 11 continuing provision of quality, cost-effective health services 12 throughout the Commonwealth by providing current, accurate data 13 and information to the purchasers and consumers of health care 14 on both cost and quality of health care services and to public 15 officials for the purpose of determining health-related programs 16 and policies and to assure access to health care services. 17 Nothing in this act shall prohibit a purchaser from obtaining 18 from its third-party insurer, carrier or administrator, nor 19 relieve said third-party insurer, carrier or administrator from 20 the obligation of providing, on terms consistent with past 21 practices, data previously provided to a purchaser pursuant to 22 any existing or future arrangement, agreement or understanding. 23 Section 3. Definitions. 24 The following words and phrases when used in this act shall 25 have the meanings given to them in this section unless the 26 context clearly indicates otherwise: 27 "Ambulatory service facility." A facility licensed in this 28 Commonwealth, not part of a hospital, which provides medical, 29 diagnostic or surgical treatment to patients not requiring 30 hospitalization, including ambulatory surgical facilities, 20030S0387B1076 - 3 -
1 ambulatory imaging or diagnostic centers, birthing centers, 2 freestanding emergency rooms and any other facilities providing 3 ambulatory care which charge a separate facility charge. This 4 term does not include the offices of private physicians or 5 dentists, whether for individual or group practices. 6 "Charge" or "rate." The amount billed by a provider for 7 specific goods or services provided to a patient, prior to any 8 adjustment for contractual allowances. 9 "Council." The Health Care Cost Containment Council. 10 "Covered services." Any health care services or procedures 11 connected with episodes of illness that require either inpatient 12 hospital care or major ambulatory service such as surgical, 13 medical or major radiological procedures, including any initial 14 and follow-up outpatient services associated with the episode of 15 illness before, during or after inpatient hospital care or major 16 ambulatory service. The term does not include routine outpatient 17 services connected with episodes of illness that do not require 18 hospitalization or major ambulatory service. 19 "Data source." A hospital; ambulatory service facility; 20 physician; health maintenance organization as defined in the act 21 of December 29, 1972 (P.L.1701, No.364), known as the Health 22 Maintenance Organization Act; hospital, medical or health 23 service plan with a certificate of authority issued by the 24 Insurance Department, including, but not limited to, hospital 25 plan corporations as defined in 40 Pa.C.S. Ch. 61 (relating to 26 hospital plan corporations) and professional health services 27 plan corporations as defined in 40 Pa.C.S. Ch. 63 (relating to 28 professional health services plan corporations); commercial 29 insurer with a certificate of authority issued by the Insurance 30 Department providing health or accident insurance; self-insured 20030S0387B1076 - 4 -
1 employer providing health or accident coverage or benefits for 2 employees employed in the Commonwealth; administrator of a self- 3 insured or partially self-insured health or accident plan 4 providing covered services in the Commonwealth; any health and 5 welfare fund that provides health or accident benefits or 6 insurance pertaining to covered service in the Commonwealth; the 7 Department of Public Welfare for those covered services it 8 purchases or provides through the medical assistance program 9 under the act of June 13, 1967 (P.L.31, No.21), known as the 10 Public Welfare Code, and any other payor for covered services in 11 the Commonwealth other than an individual. 12 "Health care facility." A general or special hospital, 13 including tuberculosis and psychiatric hospitals, kidney disease 14 treatment centers, including freestanding hemodialysis units, 15 and ambulatory service facilities as defined in this section, 16 and hospices, both profit and nonprofit, and including those 17 operated by an agency of State or local government. 18 "Health care insurer." Any person, corporation or other 19 entity that offers administrative, indemnity or payment services 20 for health care in exchange for a premium or service charge 21 under a program of health care benefits, including, but not 22 limited to, an insurance company, association or exchange 23 issuing health insurance policies in this Commonwealth; hospital 24 plan corporation as defined in 40 Pa.C.S. Ch. 61 (relating to 25 hospital plan corporations); professional health services plan 26 corporation as defined in 40 Pa.C.S. Ch. 63 (relating to 27 professional health services plan corporations); health 28 maintenance organization; preferred provider organization; 29 fraternal benefit societies; beneficial societies; and third- 30 party administrators; but excluding employers, labor unions or 20030S0387B1076 - 5 -
1 health and welfare funds jointly or separately administered by 2 employers or labor unions that purchase or self-fund a program 3 of health care benefits for their employees or members and their 4 dependents. 5 "Health maintenance organization." An organized system which 6 combines the delivery and financing of health care and which 7 provides basic health services to voluntarily enrolled 8 subscribers for a fixed prepaid fee, as defined in the act of 9 December 29, 1972 (P.L.1701, No.364), known as the Health 10 Maintenance Organization Act. 11 "Hospital." An institution, licensed in this Commonwealth, 12 which is a general, tuberculosis, mental, chronic disease or 13 other type of hospital, or kidney disease treatment center, 14 whether profit or nonprofit, and including those operated by an 15 agency of State or local government. 16 "Indigent care." The actual costs, as determined by the 17 council, for the provision of appropriate health care, on an 18 inpatient or outpatient basis, given to individuals who cannot 19 pay for their care because they are above the medical assistance 20 eligibility levels and have no health insurance or other 21 financial resources which can cover their health care. 22 "Major ambulatory service." Surgical or medical procedures, 23 including diagnostic and therapeutic radiological procedures, 24 commonly performed in hospitals or ambulatory service 25 facilities, which are not of a type commonly performed or which 26 cannot be safely performed in physicians' offices and which 27 require special facilities such as operating rooms or suites or 28 special equipment such as fluoroscopic equipment or computed 29 tomographic scanners, or a postprocedure recovery room or short- 30 term convalescent room. 20030S0387B1076 - 6 -
1 "Medical procedure incidence variations." The variation in 2 the incidence in the population of specific medical, surgical 3 and radiological procedures in any given year, expressed as a 4 deviation from the norm, as these terms are defined in the 5 classical statistical definition of "variation," "incidence," 6 "deviation" and "norm." 7 "Medically indigent" or "indigent." The status of a person 8 as described in the definition of indigent care. 9 "Payment." The payments that providers actually accept for 10 their services, exclusive of charity care, rather than the 11 charges they bill. 12 "Payor." Any person or entity, including, but not limited 13 to, health care insurers and purchasers, that make direct 14 payments to providers for covered services. 15 "Physician." An individual licensed under the laws of this 16 Commonwealth to practice medicine and surgery within the scope 17 of the act of October 5, 1978 (P.L.1109, No.261), known as the 18 Osteopathic Medical Practice Act, or the act of December 20, 19 1985 (P.L.457, No.112), known as the Medical Practice Act of 20 1985. 21 "Preferred provider organization." Any arrangement between a 22 health care insurer and providers of health care services which 23 specifies rates of payment to such providers which differ from 24 their usual and customary charges to the general public and 25 which encourage enrollees to receive health services from such 26 providers. 27 "Provider." A hospital, an ambulatory service facility or a 28 physician. 29 "Provider quality." The extent to which a provider renders 30 care that, within the capabilities of modern medicine, obtains 20030S0387B1076 - 7 -
1 for patients medically acceptable health outcomes and prognoses, 2 adjusted for patient severity, and treats patients 3 compassionately and responsively. 4 "Provider service effectiveness." The effectiveness of 5 services rendered by a provider, determined by measurement of 6 the medical outcome of patients grouped by severity receiving 7 those services. 8 "Purchaser." All corporations, labor organizations and other 9 entities that purchase benefits which provide covered services 10 for their employees or members, either through a health care 11 insurer or by means of a self-funded program of benefits, and a 12 certified bargaining representative that represents a group or 13 groups of employees for whom employers purchase a program of 14 benefits which provide covered services, but excluding entities 15 defined in this section as "health care insurers." 16 "Raw data" or "data." Data collected by the council under 17 section 6 in the form initially received. No data shall be 18 released by the council except as provided for in section 11. 19 "Severity." In any patient, the measureable degree of the 20 potential for failure of one or more vital organs. 21 Section 2. Sections 4, 5, 6 and 7 of the act are reenacted 22 and amended to read: 23 Section 4. Health Care Cost Containment Council. 24 (a) Establishment.--The General Assembly hereby establishes 25 an independent council to be known as the Health Care Cost 26 Containment Council. 27 (b) Composition.--The council shall consist of [21] voting 28 members, composed of and appointed in accordance with the 29 following: 30 (1) The Secretary of Health. 20030S0387B1076 - 8 -
1 (2) The Secretary of Public Welfare. 2 (3) The Insurance Commissioner. 3 (3.1) Four members of the General Assembly, which shall <-- 4 consist of the chairman and minority chairman of the Public 5 Health and Welfare Committee of the Senate and the chairman 6 and minority chairman of the Health and Human Services 7 Committee of the House of Representatives. Members under this 8 paragraph may appoint a designee to act on behalf of the 9 member at meetings of the council and of committees, as 10 provided in subsection (f). Designees shall be counted for 11 purposes of determining a quorum. 12 (4) Six representatives of the business community, at 13 least one of whom represents small business, who are 14 purchasers of health care as defined in section 3, none of 15 which is primarily involved in the provision of health care 16 or health insurance, three of which shall be appointed by the 17 President pro tempore of the Senate and three of which shall 18 be appointed by the Speaker of the House of Representatives 19 from a list of twelve qualified persons recommended by the 20 Pennsylvania Chamber of Business and Industry. Three nominees 21 shall be representatives of small business. 22 (5) Six representatives of organized labor, three of 23 which shall be appointed by the President pro tempore of the 24 Senate and three of which shall be appointed by the Speaker 25 of the House of Representatives from a list of twelve 26 qualified persons recommended by the Pennsylvania AFL-CIO. 27 (6) One representative of consumers who is not primarily 28 involved in the provision of health care or health care 29 insurance, appointed by the Governor from a list of three 30 qualified persons recommended jointly by the Speaker of the 20030S0387B1076 - 9 -
1 House of Representatives and the President pro tempore of the 2 Senate. 3 (6.1) One representative of patient advocacy groups <-- 4 appointed by the Governor, who must be an employee of a not- 5 for-profit patient safety advocacy organization. 6 (7) [One representative] Three TWO representatives of <-- 7 hospitals, appointed by the Governor from a list of [three] 8 five qualified hospital representatives recommended by the 9 Hospital and Health System Association of Pennsylvania ONE OF <-- 10 WHOM SHALL BE A REPRESENTATIVE OF RURAL HOSPITALS. 11 Representatives under this paragraph shall include one <-- 12 representative of academic teaching hospitals and one 13 representative of rural hospitals. [The] Each representative 14 under this paragraph may appoint two additional delegates to 15 act for the representative only at meetings of committees, as 16 provided for in subsection (f). 17 (8) [One representative] Two representatives of 18 physicians, appointed by the Governor from a list of [three] <-- 19 FIVE qualified physician representatives recommended jointly <-- 20 by the Pennsylvania Medical Society and the Pennsylvania 21 Osteopathic Medical Society. The representative under this 22 paragraph may appoint two additional delegates to act for the 23 representative only at meetings of committees, as provided 24 for in subsection (f). 25 (8.1) An individual appointed by the Governor who is <-- 26 certified in continuous quality improvement methods. HAS <-- 27 EXPERTISE IN THE APPLICATION OF CONTINUOUS QUALITY 28 IMPROVEMENT METHODS IN HOSPITALS. 29 (8.2) One representative of nurses, appointed by the 30 Governor from a list of three qualified representatives 20030S0387B1076 - 10 -
1 recommended by the Pennsylvania State Nurses Association. 2 (9) One representative of the Blue Cross and Blue Shield 3 plans in Pennsylvania, appointed by the Governor from a list 4 of three qualified persons recommended jointly by the Blue 5 Cross and Blue Shield plans of Pennsylvania. 6 (10) One representative of commercial insurance 7 carriers, appointed by the Governor from a list of three 8 qualified persons recommended by the Insurance Federation of 9 Pennsylvania, Inc. 10 (11) One representative of health maintenance 11 organizations, appointed by the Governor from a list of three 12 qualified persons recommended by the [Pennsylvania 13 Association of Health Maintenance Organizations] Managed Care 14 Association of Pennsylvania. 15 (12) In the case of each appointment to be made from a 16 list supplied by a specified organization, it is incumbent 17 upon that organization to consult with and provide a list 18 which reflects the input of other equivalent organizations 19 representing similar interests. Each appointing authority 20 will have the discretion to request additions to the list 21 originally submitted. Additional names will be provided not 22 later than 15 days after such request. Appointments shall be 23 made by the appointing authority no later than 90 days after 24 receipt of the original list. If, for any reason, any 25 specified organization supplying a list should cease to 26 exist, then the respective appointing authority shall specify 27 a new equivalent organization to fulfill the responsibilities 28 of this act. 29 (c) Chairperson and vice chairperson.--The members shall 30 annually elect, by a majority vote of the members, a chairperson 20030S0387B1076 - 11 -
1 and a vice chairperson of the council from among the business 2 and labor representatives on the council. 3 (d) Quorum.--[Eleven] Seventeen THIRTEEN members, [a <-- 4 majority of which in any combination shall] at least six of whom 5 must be made up of representatives of business and labor, shall 6 constitute a quorum for the transaction of any business, and the 7 act by the majority of the members present at any meeting in 8 which there is a quorum shall be deemed to be the act of the 9 council. 10 (e) Meetings.--All meetings of the council shall be 11 advertised and conducted pursuant to [the act of July 3, 1986 12 (P.L.388, No.84), known as the Sunshine Act] 65 Pa.C.S. Ch. 7 13 (relating to open meetings), unless otherwise provided in this 14 section. 15 (1) The council shall meet at least once every two 16 months, and may provide for special meetings as it deems 17 necessary. Meeting dates shall be set by a majority vote of 18 the members of the council or by the call of the chairperson 19 upon seven days' notice to all council members. 20 (2) All meetings of the council shall be publicly 21 advertised, as provided for in this subsection, and shall be 22 open to the public, except that the council, through its 23 bylaws, may provide for executive sessions of the council on 24 subjects permitted to be discussed in such sessions under 25 [the Sunshine Act] 65 Pa.C.S. Ch. 7. No act of the council 26 shall be taken in an executive session. 27 (3) The council shall publish a schedule of its meetings 28 in the Pennsylvania Bulletin and in at least one newspaper in 29 general circulation in the Commonwealth. Such notice shall be 30 published at least once in each calendar quarter and shall 20030S0387B1076 - 12 -
1 list the schedule of meetings of the council to be held in 2 the subsequent calendar quarter. Such notice shall specify 3 the date, time and place of the meeting and shall state that 4 the council's meetings are open to the general public, except 5 that no such notice shall be required for executive sessions 6 of the council. 7 (4) All action taken by the council shall be taken in 8 open public session, and action of the council shall not be 9 taken except upon the affirmative vote of a majority of the 10 members of the council present during meetings at which a 11 quorum is present. 12 (f) Bylaws.--The council shall adopt bylaws, not 13 inconsistent with this act, and may appoint such committees or 14 elect such officers subordinate to those provided for in 15 subsection (c) as it deems advisable. The council shall provide 16 for the approval and participation of additional delegates 17 appointed under subsection (b)(7) and (8) so that each 18 organization represented by delegates under those paragraphs 19 shall not have more than one vote on any committee to which they 20 are appointed. The council shall also appoint a technical 21 advisory group which shall, on an ad hoc basis, respond to 22 issues presented to it by the council or committees of the 23 council and shall make recommendations to the council. The 24 technical advisory group shall include physicians, researchers 25 [and biostatisticians.], biostatisticians, one representative of 26 the Hospital and Healthsystem Association of Pennsylvania and 27 one representative of the Pennsylvania Medical Society. The 28 Hospital and Healthsystem Association of Pennsylvania and the 29 Pennsylvania Medical Society representatives shall not be 30 subject to executive committee approval. In appointing OTHER <-- 20030S0387B1076 - 13 -
1 physicians, researchers and biostatisticians to the technical 2 advisory group, the council shall consult with and take 3 nominations from the representatives of the Hospital Association 4 of Pennsylvania, the Pennsylvania Medical Society, the 5 Pennsylvania Osteopathic Medical Society or other like 6 organizations. At its discretion and in accordance with this 7 section, nominations shall be approved by the executive 8 committee of the council. If the subject matter of any project 9 exceeds the expertise of the technical advisory group, 10 physicians in appropriate specialties who possess current 11 knowledge of the issue under study may be consulted. The 12 technical advisory group shall also review the availability and 13 reliability of severity of illness measurements as they relate 14 to small hospitals and psychiatric, rehabilitation and 15 children's hospitals and shall make recommendations to the 16 council based upon this review. 17 (g) Compensation and expenses.--The members of the council 18 shall not receive a salary or per diem allowance for serving as 19 members of the council but shall be reimbursed for actual and 20 necessary expenses incurred in the performance of their duties. 21 Said expenses may include reimbursement of travel and living 22 expenses while engaged in council business. 23 (h) Terms of council members.-- 24 (1) The terms of the Secretary of Health, the Secretary 25 of Public Welfare and the Insurance Commissioner shall be 26 concurrent with their holding of public office. The [eighteen 27 appointed] council members under subsection (b)(1), (2), (3) <-- 28 and (3.1) shall serve ex officio. The council members under 29 subsection (b)(4) through (11) shall each serve for a term of 30 [three] four years and shall continue to serve thereafter 20030S0387B1076 - 14 -
1 until their successor is appointed[, except that, of the <-- 2 members first appointed: 3 (i) Two each of the representatives of business and 4 organized labor and the representative of consumers shall 5 serve for a term to expire on June 30 of the year 6 following their appointment. 7 (ii) Two each of the representatives of business and 8 organized labor and the representatives of the Blue Cross 9 and Blue Shield plans of Pennsylvania and the commercial 10 insurance carriers shall serve for a term to expire on 11 June 30 of the second year following their appointment. 12 (iii) Two each of the representatives of business 13 and organized labor and the representatives of hospitals, 14 physicians and health maintenance organizations shall 15 serve for a term to expire on June 30 of the third year 16 following their appointment]. <-- 17 (2) Vacancies on the council shall be filled in the 18 [same] manner [in which they were originally] designated <-- 19 under subsection (b), within 60 days of the vacancy, except 20 that when vacancies occur among the representatives of 21 business or organized labor, two nominations shall be 22 submitted by the organization specified in subsection (b) for 23 each vacancy on the council. If the officer required in 24 subsection (b) to make appointments to the council fails to 25 act within 60 days of the vacancy, the council chairperson 26 may appoint one of the persons recommended for the vacancy 27 until the appointing authority makes the appointment. 28 (3) A member may be removed for just cause by the 29 appointing authority after recommendation by a vote of at 30 least 14 members of the council. 20030S0387B1076 - 15 -
1 (4) No appointed member under subsection (b)(4) through 2 (11) shall be eligible to serve more than two full 3 consecutive terms of four years beginning on July 1, 2003 THE <-- 4 EFFECTIVE DATE OF THIS PARAGRAPH. 5 [(i) Commencement of operations.-- <-- 6 (1) Within 60 days after the effective date of this act, 7 each organization or individual required to submit a list of 8 recommended persons to the Governor, the President pro 9 tempore of the Senate or the Speaker of the House of 10 Representatives under subsection (b) shall submit said list. 11 (2) Within 90 days of the effective date of this act, 12 the Governor, the President pro tempore of the Senate and the 13 Speaker of the House of Representatives shall make all of the 14 appointments called for in subsection (b), and the council 15 shall begin operations immediately following these 16 appointments.] <-- 17 (j) Subsequent appointments.--Submission of lists of 18 recommended persons and appointments of council members for [the <-- 19 second and] succeeding terms shall be made in the same manner as <-- 20 prescribed in subsection (b), except that: 21 (1) Organizations required under subsection (b) to 22 submit lists of recommended persons shall do so at least 60 23 days prior to expiration of the council members' terms. 24 (2) The officer required under subsection (b) to make 25 appointments to the council shall make said appointments at 26 least 30 days prior to expiration of the council members' 27 terms. If the appointments are not made within the specified 28 time, the council chairperson may make interim appointments 29 from the lists of recommended individuals. An interim 30 appointment shall be valid only until the appropriate officer 20030S0387B1076 - 16 -
1 under subsection (b) makes the required appointment. Whether 2 the appointment is by the required officer or by the 3 chairperson of the council, the appointment shall become 4 effective immediately upon expiration of the incumbent 5 member's term. 6 [(k) Appointments of acting councilors.--Should any <-- 7 organization or individual fail to submit a list of recommended 8 persons as required under subsection (b) within the time limits 9 in subsection (i) or (j), the officer designated to make the 10 appointment under subsection (b) shall appoint as many acting 11 councilors as required under subsection (b) until such time as 12 the list of recommended persons is submitted by the original 13 organization as required in subsection (b).] <-- 14 Section 5. Powers and duties of the council. 15 (a) General powers.--The council shall exercise all powers 16 necessary and appropriate to carry out its duties, including the 17 following: 18 (1) To employ an executive director, investigators and 19 other staff necessary to comply with the provisions of this 20 act and regulations promulgated thereunder, to employ or 21 retain legal counsel and to engage professional consultants, 22 as it deems necessary to the performance of its duties. Any 23 consultants, other than sole source consultants, engaged by 24 the council shall be selected in accordance with the 25 provisions for contracting with vendors set forth in section 26 16. 27 (2) To fix the compensation of all employees and to 28 prescribe their duties. Notwithstanding the independence of 29 the council under section 4(a), employees under this 30 paragraph shall be deemed employees of the Commonwealth for 20030S0387B1076 - 17 -
1 the purposes of participation in the Pennsylvania Employee 2 Benefit Trust Fund. 3 (3) To make and execute contracts and other instruments, 4 including those for purchase of services and purchase or 5 leasing of equipment and supplies, necessary or convenient to 6 the exercise of the powers of the council. Any such contract 7 shall be let only in accordance with the provision for 8 contracting with vendors set forth in section 16. 9 (4) To conduct examinations and investigations, to 10 conduct audits, pursuant to the provisions of subsection (c), 11 and to hear testimony and take proof, under oath or 12 affirmation, at public or private hearings, on any matter 13 necessary to its duties. 14 (4.1) To provide hospitals with individualized data on 15 adverse medical events, complications and hospital infections <-- 16 PATIENT SAFETY INDICATORS PURSUANT TO SECTION 6(C)(7). The <-- 17 data shall be risk adjusted and made available to hospitals 18 electronically and free of charge on a quarterly basis within 19 45 days of receipt of the corrected quarterly data from the 20 hospitals. The data is intended to provide the patient safety 21 committee of each hospital with information necessary to 22 assist it in conducting route cause PATIENT SAFETY analysis. <-- 23 (5) To do all things necessary to carry out its duties 24 under the provisions of this act. 25 (b) Rules and regulations.--The council [may, in a manner 26 provided by law, promulgate rules and regulations] shall 27 promulgate rules and regulations in accordance with the act of 28 June 25, 1982 (P.L.633, No.181), known as the Regulatory Review 29 Act, necessary to carry out its duties under this act. This 30 subsection shall not apply to regulations in effect on June 30, 20030S0387B1076 - 18 -
1 2003.
2 (c) Audit powers.--The council shall have the right to
3 independently audit all information required to be submitted by
4 data sources as needed to corroborate the accuracy of the
5 submitted data, pursuant to the following:
6 (1) Audits of information submitted by providers or
7 health care insurers shall be performed on a sample and
8 issue-specific basis, as needed by the council, and shall be
9 coordinated, to the extent practicable, with audits performed
10 by the Commonwealth. All health care insurers and providers
11 are hereby required to make those books, records of accounts
12 and any other data needed by the auditors available to the
13 council at a convenient location within 30 days of a written
14 notification by the council.
15 (2) Audits of information submitted by purchasers shall
16 be performed on a sample basis, unless there exists
17 reasonable cause to audit specific purchasers, but in no case
18 shall the council have the power to audit financial
19 statements of purchasers.
20 (3) All audits performed by the council shall be
21 performed at the expense of the council.
22 (d) General duties and functions.--The council is hereby
23 authorized to and shall perform the following duties and
24 functions:
25 (1) Develop a computerized system for the collection,
26 analysis and dissemination of data. The council may contract
27 with a vendor who will provide such data processing services.
28 The council shall assure that the system will be capable of
29 processing all data required to be collected under this act.
30 Any vendor selected by the council shall be selected in
20030S0387B1076 - 19 -
1 accordance with the provisions of section 16, and said vendor 2 shall relinquish any and all proprietary rights or claims to 3 the data base created as a result of implementation of the 4 data processing system. 5 (2) Establish a Pennsylvania Uniform Claims and Billing 6 Form for all data sources and all providers which shall be 7 utilized and maintained by all data sources and all providers 8 for all services covered under this act. 9 (3) Collect and disseminate data, as specified in 10 section 6, and other information from data sources to which 11 the council is entitled, prepared according to formats, time 12 frames and confidentiality provisions as specified in 13 sections 6 and 10, and by the council. 14 (4) Adopt and implement a methodology to collect and 15 disseminate data reflecting provider quality and provider 16 service effectiveness pursuant to section 6 [and to 17 continuously study quality of care systems]. 18 (5) Subject to the restrictions on access to raw data 19 set forth in section 10, issue special reports and make 20 available raw data as defined in section 3 to any purchaser 21 requesting it. Sale by any recipient or exchange or 22 publication by a recipient, other than a purchaser, of raw 23 council data to other parties without the express written 24 consent of, and under terms approved by, the council shall be 25 unauthorized use of data pursuant to section 10(c). 26 (6) On an annual basis, publish in the Pennsylvania 27 Bulletin a list of all the raw data reports it has prepared 28 under section 10(f) and a description of the data obtained 29 through each computer-to-computer access it has provided 30 under section 10(f) and of the names of the parties to whom 20030S0387B1076 - 20 -
1 the council provided the reports or the computer-to-computer 2 access during the previous month. 3 (7) Promote competition in the health care and health 4 insurance markets. 5 (8) Assure that the use of council data does not raise 6 access barriers to care. 7 (10) Make annual reports to the General Assembly on the 8 rate of increase in the cost of health care in the 9 Commonwealth and the effectiveness of the council in carrying 10 out the legislative intent of this act. In addition, the 11 council may make recommendations on the need for further 12 health care cost containment legislation. The council shall 13 also make annual reports to the General Assembly on the 14 quality and effectiveness of health care and access to health 15 care for all citizens of the Commonwealth. 16 [(11) Adopt, within one year, a model patient itemized 17 statement for all providers, which itemizes all charges for 18 services, equipment, supplies and medicine, designed to be 19 more understandable than current patient bills. Each provider 20 shall be required to utilize said model patient itemized 21 statement for covered services within 90 days of adoption of 22 said form by the council. Such model patient itemized 23 statements shall be written in language that is 24 understandable to the average person and be presented to each 25 patient upon discharge from a health care facility or 26 provision of patient services or within a reasonable time 27 thereafter. Patients may request a copy of their Pennsylvania 28 Uniform Claims and Billing Form, and, upon request, the 29 provider shall furnish this form to the patient within 30 30 days.] 20030S0387B1076 - 21 -
1 (12) Conduct studies and publish reports thereon 2 analyzing the effects that noninpatient, alternative health 3 care delivery systems have on health care costs. These 4 systems shall include, but not be limited to: HMO's; PPO's; 5 primary health care facilities; home health care; attendant 6 care; ambulatory service facilities; freestanding emergency 7 centers; birthing centers; and hospice care. These reports 8 shall be submitted to the General Assembly and shall be made 9 available to the public. 10 (13) Conduct studies and make reports concerning the 11 utilization of experimental and nonexperimental transplant 12 surgery and other highly technical and experimental 13 procedures, including costs and mortality rates. 14 (14) In order to insure ENSURE that the council adopts <-- 15 and maintains both scientifically credible and cost-effective 16 methodology to collect and disseminate data reflecting 17 provider quality and effectiveness, the council shall, within 18 one year of the effective date of this paragraph, utilizing 19 current Commonwealth agency guidelines and procedures, issue 20 a request for information from any vendor that wishes to 21 provide data collection or risk adjustment methodology to the 22 council to help meet the requirements of this subsection and 23 section 6. The council shall establish an independent Request 24 for Information Review Committee to review and rank all 25 responses and to make a final recommendation to the council. 26 The Request for Information Review Committee shall consist of 27 the following members: <-- 28 (i) Four members of the General Assembly, one each 29 to be appointed by the President Pro Tempore of the 30 Senate, the Minority Leader of the Senate, the Speaker of 20030S0387B1076 - 22 -
1 the House of Representatives and the Minority Leader of 2 the House of Representatives. 3 (ii) The following members appointed by the 4 Governor: 5 (A) One representative of the Hospital and 6 Healthsystem Association of Pennsylvania. 7 (B) One representative of the Pennsylvania 8 Medical Society. 9 (C) One representative of insurance. 10 (D) One representative of labor. 11 (E) One representative of business. 12 (F) Two representatives of the general public. 13 THE FOLLOWING MEMBERS APPOINTED BY THE GOVERNOR: <-- 14 (I) ONE REPRESENTATIVE OF THE HOSPITAL AND 15 HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA. 16 (II) ONE REPRESENTATIVE OF THE PENNSYLVANIA MEDICAL 17 SOCIETY. 18 (III) ONE REPRESENTATIVE OF INSURANCE. 19 (IV) ONE REPRESENTATIVE OF LABOR. 20 (V) ONE REPRESENTATIVE OF BUSINESS. 21 (VI) TWO REPRESENTATIVES OF THE GENERAL PUBLIC. 22 (15) The council shall execute a request for quotations <-- 23 with a PROPOSALS WITH third-party vendor VENDORS for the <-- 24 purpose of demonstrating a methodology for the collection, 25 analysis and reporting of hospital-specific complication 26 rates. The results of this demonstration shall be shared with <-- 27 the General Assembly. The council may recommend that this 28 PROVIDED TO THE CHAIRMAN AND MINORITY CHAIRMAN OF THE PUBLIC <-- 29 HEALTH AND WELFARE COMMITTEE OF THE SENATE AND THE CHAIRMAN 30 AND MINORITY CHAIRMAN OF THE HEALTH AND HUMAN SERVICES 20030S0387B1076 - 23 -
1 COMMITTEE OF THE HOUSE OF REPRESENTATIVES. THIS methodology 2 be utilized for its MAY BE UTILIZED BY THE COUNCIL FOR public <-- 3 reporting on comparative hospital complication rates. 4 Section 6. Data submission and collection. 5 (a) (1) Submission of data.--The council is hereby 6 authorized to collect and data sources are hereby required to 7 submit, upon request of the council, all data required in 8 this section, according to uniform submission formats, coding 9 systems and other technical specifications necessary to 10 render the incoming data substantially valid, consistent, 11 compatible and manageable using electronic data processing 12 according to data submission schedules, such schedules to 13 avoid, to the extent possible, submission of identical data 14 from more than one data source, established and promulgated 15 by the council in regulations pursuant to its authority under 16 section 5(b). If payor data is requested by the council, it 17 shall, to the extent possible, be obtained from primary payor 18 sources. 19 (2) Except as provided in this section, the council may 20 adopt any nationally recognized methodology to adjust data 21 submitted under subsection (c) for severity of illness. Every 22 three years after the effective date of this paragraph, the 23 council shall solicit bids from third-party vendors to adjust 24 the data. The solicitation shall be in accordance with 62 25 Pa.C.S. (relating to procurement). Except as provided in 26 subparagraph (i), in carrying out its responsibilities, the 27 council shall not require health care facilities to report 28 data elements which are not included in the manual developed 29 by the national uniform billing committee. The following 30 apply: 20030S0387B1076 - 24 -
1 (i) Within 60 days of the effective date of this 2 paragraph, the council shall publish in the Pennsylvania 3 Bulletin a list of diseases, procedures and medical 4 conditions, not to exceed 35, for which data under 5 subsections (c)(21) and (d) shall be required. The chosen 6 list shall not represent more than 50% of total hospital 7 discharges, based upon the previous year's hospital 8 discharge data. Subsequent to the publication of the 9 list, any data submission requirements under subsections 10 (c)(21) and (d) previously in effect shall be null and 11 void for diseases, procedures and medical conditions not 12 found on the list. All other data elements pursuant to 13 subsection (c) shall continue to be required from data 14 sources. The council shall review the list and may add no 15 more than a net of three diseases, procedures or medical 16 conditions per year over a five-year period starting on 17 the effective date of this subparagraph. The adjusted 18 list of diseases, procedures and medical conditions shall 19 at no time be more than 50% of total hospital discharges. 20 (ii) If the current data vendor is unable to 21 achieve, on a per-chart basis, savings of at least 40% in 22 the cost of hospital compliance with the data abstracting 23 and submission requirements of this act by June 30, 2004, 24 as compared to June 30, 2003, then the council shall 25 disqualify the current vendor and reopen the bidding 26 process. The independent auditor shall determine the 27 extent and validity of the savings. In determining any 28 demonstrated cost savings, surveys of all hospitals in 29 this Commonwealth shall be conducted and consideration 30 shall be given at a minimum to: 20030S0387B1076 - 25 -
1 (A) new costs, in terms of making the 2 methodology operational, associated with laboratory, 3 pharmacy and other information systems a hospital is 4 required to purchase in order to reduce hospital 5 compliance costs, including the cost of electronic 6 transfer of required data; and 7 (B) the audited direct personnel and related 8 costs of data abstracting and submission required. 9 (iii) Review by the independent auditor shall 10 commence by March 1, 2004, and shall conclude with a 11 report of findings by July 31, 2004. The report shall be 12 delivered to the council, the Governor, the Health and 13 Human Services Committee of the House of Representatives 14 and the Public Health and Welfare Committee of the 15 Senate. 16 (a.1) Abstraction and technology work group.-- 17 (1) The council shall establish a data abstraction and 18 technology work group to produce recommendations for 19 improving and refining the data required by the council and 20 reducing, through innovative direct data collection 21 techniques, the cost of collecting required data. The work 22 group shall consist of the following members appointed by the 23 council: 24 (i) one member representing the Office of Health 25 Care Reform; 26 (ii) one member representing the business community; 27 (iii) one member representing labor; 28 (iv) one member representing consumers; 29 (v) two members representing physicians; 30 (vi) two members representing nurses; 20030S0387B1076 - 26 -
1 (vii) two members representing hospitals; 2 (viii) one member representing patient advocacy <-- 3 groups; 4 (ix) (VIII) one member representing health <-- 5 underwriters; and 6 (x) (IX) one member representing commercial <-- 7 insurance carriers. 8 (2) The work group, with approval of the council, may 9 hire an independent evaluator AUDITOR to determine the value <-- 10 of various data sets. The work group shall have no more than 11 one year to study current data requirements and methods of 12 collecting and transferring data and to make recommendations 13 for changes to produce a 50% overall reduction in the cost of 14 collecting and reporting required data to the council while 15 maintaining the scientific credibility of the council's 16 analysis and reporting. The work group recommendations shall 17 be presented to the council for a vote. 18 (c) Data elements.--For each covered service performed in 19 Pennsylvania, the council shall be required to collect the 20 following data elements: 21 (1) uniform patient identifier, continuous across 22 multiple episodes and providers; 23 (2) patient date of birth; 24 (3) patient sex; 25 (3.1) patient race, consistent with the method of 26 collection of race/ethnicity data by the United States Bureau 27 of the Census and the United States Standard Certificates of 28 Live Birth and Death; 29 (4) patient ZIP Code number; 30 (5) date of admission; 20030S0387B1076 - 27 -
1 (6) date of discharge; 2 (7) principal and [up to five] secondary diagnoses by <-- 3 standard code, including external cause [code] OF INJURY, <-- 4 COMPLICATION, INFECTION AND CHILDBIRTH; 5 (8) principal procedure by council-specified standard 6 code and date; 7 (9) up to three secondary procedures by council- 8 specified standard codes and dates; 9 (10) uniform health care facility identifier, continuous 10 across episodes, patients and providers; 11 (11) uniform identifier of admitting physician, by 12 unique physician identification number established by the 13 council, continuous across episodes, patients and providers; 14 (12) uniform identifier of consulting physicians, by 15 unique physician identification number established by the 16 council, continuous across episodes, patients and providers; 17 (13) total charges of health care facility, segregated 18 into major categories, including, but not limited to, room 19 and board, radiology, laboratory, operating room, drugs, 20 medical supplies and other goods and services according to 21 guidelines specified by the council; 22 (14) actual payments to health care facility, 23 segregated, if available, according to the categories 24 specified in paragraph (13); 25 (15) charges of each physician or professional rendering 26 service relating to an incident of hospitalization or 27 treatment in an ambulatory service facility; 28 (16) actual payments to each physician or professional 29 rendering service pursuant to paragraph (15); 30 (17) uniform identifier of primary payor; 20030S0387B1076 - 28 -
1 (18) ZIP Code number of facility where health care 2 service is rendered; 3 (19) uniform identifier for payor group contract number; 4 (20) patient discharge status; [and] 5 (21) provider service effectiveness and provider quality 6 pursuant to section 5(d)(4) and subsection (d).[.]; <-- 7 (22) all external cause of injury codes, commonly called 8 E-codes; 9 (23) codes indicating complications; 10 (24) codes indicating infections; and 11 (25) baby and mother birth codes. 12 (d) Provider quality and provider service effectiveness data 13 elements.--In carrying out its duty to collect data on provider 14 quality and provider service effectiveness under section 5(d)(4) 15 and subsection (c)(21), the council shall define a methodology 16 to measure provider service effectiveness which may include 17 additional data elements to be specified by the council 18 sufficient to carry out its responsibilities under section 19 5(d)(4). The council may adopt a nationally recognized 20 methodology of quantifying and collecting data on provider 21 quality and provider service effectiveness until such time as 22 the council has the capability of developing its own methodology 23 and standard data elements. The council shall include in the 24 Pennsylvania Uniform Claims and Billing Form a field consisting 25 of the data elements required pursuant to subsection (c)(21) to 26 provide information on each provision of covered services 27 sufficient to permit analysis of provider quality and provider 28 service effectiveness within 180 days of commencement of its 29 operations pursuant to section 4. In carrying out its 30 responsibilities, the council shall not require health care 20030S0387B1076 - 29 -
1 insurers to report on data elements that are not reported to 2 nationally recognized accrediting organizations, to the 3 Department of Health or to the Insurance Department in quarterly 4 or annual reports. The council shall not require reporting by 5 health care insurers in different formats than are required for 6 reporting to nationally recognized accrediting organizations or 7 on quarterly or annual reports submitted to the Department of 8 Health or to the Insurance Department. The council may adopt the 9 quality findings as reported to nationally recognized 10 accrediting organizations. 11 (e) Reserve field utilization and addition or deletion of 12 data elements.--The council shall include in the Pennsylvania 13 Uniform Claims and Billing Form a reserve field. The council may 14 utilize the reserve field by adding other data elements beyond 15 those required to carry out its responsibilities under section 16 5(d)(3) and (4) and subsections (c) and (d), or the council may 17 delete data elements from the Pennsylvania Uniform Claims and 18 Billing Form only by a majority vote of the council and only 19 pursuant to the following procedure: 20 (1) The council shall obtain a cost-benefit analysis of 21 the proposed addition or deletion which shall include the 22 cost to data sources of any proposed additions. 23 (2) The council shall publish notice of the proposed 24 addition or deletion, along with a copy or summary of the 25 cost-benefit analysis, in the Pennsylvania Bulletin, and such 26 notice shall include provision for a 60-day comment period. 27 (3) The council may hold additional hearings or request 28 such other reports as it deems necessary and shall consider 29 the comments received during the 60-day comment period and 30 any additional information gained through such hearings or 20030S0387B1076 - 30 -
1 other reports in making a final determination on the proposed 2 addition or deletion. 3 (f) Other data required to be submitted.--Providers are 4 hereby required to submit and the council is hereby authorized 5 to collect, in accordance with submission dates and schedules 6 established by the council, the following additional data, 7 provided such data is not available to the council from public 8 records: 9 (1) Audited annual financial reports of all hospitals 10 and ambulatory service facilities providing covered services 11 as defined in section 3. 12 (2) The Medicare cost report (OMB Form 2552 or 13 equivalent Federal form), or the AG-12 form for Medical 14 Assistance or successor forms, whether completed or partially 15 completed, and including the settled Medicare cost report and 16 the certified AG-12 form. 17 (3) Additional data, including, but not limited to, data 18 which can be used to provide at least the following 19 information: 20 (i) the incidence of medical and surgical procedures 21 in the population for individual providers; 22 (ii) physicians who provide covered services and 23 accept medical assistance patients; 24 (iii) physicians who provide covered services and 25 accept Medicare assignment as full payment; 26 (v) mortality rates for specified diagnoses and 27 treatments, grouped by severity, for individual 28 providers; 29 (vi) rates of infection for specified diagnoses and 30 treatments, grouped by severity, for individual 20030S0387B1076 - 31 -
1 providers; 2 (vii) morbidity rates for specified diagnoses and 3 treatments, grouped by severity, for individual 4 providers; 5 (viii) readmission rates for specified diagnoses and 6 treatments, grouped by severity, for individual 7 providers; and 8 (ix) rate of incidence of postdischarge professional 9 care for selected diagnoses and procedures, grouped by 10 severity, for individual providers. 11 (4) Any other data the council requires to carry out its 12 responsibilities pursuant to section 5(d). 13 (f.1) Review and correction of data.--The council shall 14 provide a reasonable period for data sources to review and 15 correct the data submitted under section 6 which the council 16 intends to prepare and issue in reports to the General Assembly, 17 to the general public or in special studies and reports under 18 section 11. When corrections are provided, the council shall 19 correct the appropriate data in its data files and subsequent 20 reports. 21 (g) Allowance for clarification or dissents.--The council 22 shall maintain a file of written statements submitted by data 23 sources who wish to provide an explanation of data that they 24 feel might be misleading or misinterpreted. The council shall 25 provide access to such file to any person and shall, where 26 practical, in its reports and data files indicate the 27 availability of such statements. When the council agrees with 28 such statements, it shall correct the appropriate data and 29 comments in its data files and subsequent reports. 30 (g.1) Allowance for correction.--The council shall verify 20030S0387B1076 - 32 -
1 the PATIENT SAFETY INDICATOR data submitted by hospitals <-- 2 pursuant to subsection (c)(22) through (25) (C)(7) within 60 <-- 3 days of receipt. The council may allow hospitals to make changes 4 to the data submitted during the verification period. After the 5 verification period, but within 45 days of receipt of the <-- 6 adjusted hospital data, the council shall risk adjust the 7 information and provide reports to the patient safety committee 8 of the relevant hospital. 9 (h) Availability of data.--Nothing in this act shall 10 prohibit a purchaser from obtaining from its health care 11 insurer, nor relieve said health care insurer from the 12 obligation of providing said purchaser, on terms consistent with 13 past practices, data previously provided or additional data not 14 currently provided to said purchaser by said health care insurer 15 pursuant to any existing or future arrangement, agreement or 16 understanding. 17 Section 7. Data dissemination and publication. 18 [(a) Public reports.--Subject to the restrictions on access 19 to council data set forth in section 10 and utilizing the data 20 collected under section 6 as well as other data, records and 21 matters of record available to it, the council shall prepare and 22 issue reports to the General Assembly and to the general public, 23 according to the following provisions: 24 (1) The council shall, for every provider within the 25 Commonwealth and within appropriate regions and subregions 26 within the Commonwealth and for those inpatient and 27 outpatient services which, when ranked by order of frequency, 28 account for at least 65% of all covered services and which, 29 when ranked by order of total payments, account for at least 30 65% of total payments, prepare and issue reports that at 20030S0387B1076 - 33 -
1 least provide information on the following: 2 (i) Comparisons among all providers of payments 3 received, charges, population-based admission or 4 incidence rates, and provider service effectiveness, such 5 comparisons to be grouped according to diagnosis and 6 severity, and to identify each provider by name and type 7 or specialty. 8 (ii) Comparisons among all providers, except 9 physicians, of inpatient and outpatient charges and 10 payments for room and board, ancillary services, drugs, 11 equipment and supplies and total services, such 12 comparisons to be grouped according to provider quality 13 and provider service effectiveness and according to 14 diagnosis and severity, and to identify each health care 15 facility by name and type. 16 (iii) Until and unless a methodology to measure 17 provider quality and provider service effectiveness 18 pursuant to sections 5(d)(4) and 6(c) and (d) is 19 available to the council, comparisons among all 20 providers, grouped according to diagnosis, procedure and 21 severity, which identify facilities by name and type and 22 physicians by name and specialty, of charges and payments 23 received, readmission rates, mortality rates, morbidity 24 rates and infection rates. Following adoption of the 25 methodology specified in sections 5(d)(4) and 6(c) and 26 (d), the council may, at its discretion, discontinue 27 publication of this component of the report. 28 (iv) The incidence rate of selected medical or 29 surgical procedures, the provider service effectiveness 30 and the payments received for those providers, identified 20030S0387B1076 - 34 -
1 by the name and type or specialty, for which these 2 elements vary significantly from the norms for all 3 providers. 4 (2) In preparing its reports under paragraph (1), the 5 council shall ensure that factors which have the effect of 6 either reducing provider revenue or increasing provider 7 costs, and other factors beyond a provider's control which 8 reduce provider competitiveness in the market place, are 9 explained in the reports. It shall also ensure that any 10 clarifications and dissents submitted by individual providers 11 under section 6(g) are noted in any reports that include 12 release of data on that individual provider. 13 (3) The council shall, for all providers within the 14 Commonwealth and within appropriate regions and subregions 15 within the Commonwealth, prepare and issue quarterly reports 16 that at least provide information on the number of 17 physicians, by specialty, on the staff of each hospital or 18 ambulatory service facility and those physicians on the staff 19 that accept Medicare assignment as full payment and that 20 accept Medical Assistance patients. 21 (4) The council shall publish all reports required in 22 this section in the Pennsylvania Bulletin and shall publish, 23 in at least one newspaper of general circulation in each 24 subregion within the Commonwealth, reports on the providers 25 in that subregion and subregions adjacent to it. In addition, 26 the council shall advertise annually the availability of 27 these reports and the charge for duplication in the 28 Pennsylvania Bulletin and in at least one newspaper of 29 general circulation in each subregion within the Commonwealth 30 at least once in each calendar quarter.] 20030S0387B1076 - 35 -
1 (a) Public reports.--Subject to the restrictions on access 2 to council data set forth in section 10 and utilizing the data 3 collected under section 6 as well as other data, records and 4 matters of record available to it, the council shall prepare and 5 issue reports to the General Assembly and to the general public, 6 according to the following provisions: 7 (1) The council shall, for every provider of both 8 inpatient and outpatient services within this Commonwealth 9 and within appropriate regions and subregions, prepare and 10 issue reports on provider quality and service effectiveness 11 on diseases or procedures that, when ranked by volume, cost, 12 payment and high variation in outcome, represent the best 13 opportunity to improve overall provider quality, improve 14 patient safety and provide opportunities for cost reduction. 15 These reports shall provide comparative information on the 16 following: 17 (i) Differences in mortality rates; differences in 18 length of stay; differences in complication rates; 19 differences in readmission rates; differences in 20 infection rates; and other comparative outcome measures 21 the council may develop that will allow purchasers, 22 providers and consumers to make purchasing and quality 23 improvement decisions based upon quality patient care and 24 to restrain costs. 25 (ii) The incidence rate of selected medical or 26 surgical procedures, the quality and service 27 effectiveness and the payments received for those 28 providers, identified by the name and type or specialty, 29 for which these elements vary significantly from the 30 norms for all providers. 20030S0387B1076 - 36 -
1 (2) In preparing its reports under paragraph (1), the 2 council shall ensure that factors which have the effect of 3 either reducing provider revenue or increasing provider costs 4 and other factors beyond a provider's control which reduce 5 provider competitiveness in the marketplace are explained in 6 the reports. The council shall also ensure that any 7 clarifications and dissents submitted by individual providers 8 under section 6(g) are noted in any reports that include 9 release of data on that individual provider. 10 (b) Raw data reports and computer access to council data.-- 11 The council shall provide special reports derived from raw data 12 and a means for computer-to-computer access to its raw data to 13 any purchaser, pursuant to section 10(f). The council shall 14 provide such reports and computer-to-computer access, at its 15 discretion, to other parties, pursuant to section 10(g). The 16 council shall provide these special reports and computer-to- 17 computer access in as timely a fashion as the council's 18 responsibilities to publish the public reports required in this 19 section will allow. Any such provision of special reports or 20 computer-to-computer access by the council shall be made only 21 subject to the restrictions on access to raw data set forth in 22 section 10(b) and only after payment for costs of preparation or 23 duplication pursuant to section 10(f) or (g). 24 Section 3. Section 8 of the act is reenacted to read: 25 Section 8. Health care for the medically indigent. 26 (a) Declaration of policy.--The General Assembly finds that 27 every person in this Commonwealth should receive timely and 28 appropriate health care services from any provider operating in 29 this Commonwealth; that, as a continuing condition of licensure, 30 each provider should offer and provide medically necessary, 20030S0387B1076 - 37 -
1 lifesaving and emergency health care services to every person in 2 this Commonwealth, regardless of financial status or ability to 3 pay; and that health care facilities may transfer patients only 4 in instances where the facility lacks the staff or facilities to 5 properly render definitive treatment. 6 (b) Studies on indigent care.--To reduce the undue burden on 7 the several providers that disproportionately treat medically 8 indigent people on an uncompensated basis, to contain the long- 9 term costs generated by untreated or delayed treatment of 10 illness and disease and to determine the most appropriate means 11 of treating and financing the treatment of medically indigent 12 persons, the council, at the request of the Governor or the 13 General Assembly, may undertake studies and utilize its current 14 data base to: 15 (1) Study and analyze the medically indigent population, 16 the magnitude of uncompensated care for the medically 17 indigent, the degree of access to and the result of any lack 18 of access by the medically indigent to appropriate care, the 19 types of providers and the settings in which they provide 20 indigent care and the cost of the provision of that care 21 pursuant to subsection (c). 22 (2) Determine, from studies undertaken under paragraph 23 (1), a definition of the medically indigent population and 24 the most appropriate method for the delivery of timely and 25 appropriate health care services to the medically indigent. 26 (c) Studies.--The council shall conduct studies pursuant to 27 subsection (b)(1) and thereafter report to the Governor and the 28 General Assembly the results of the studies and its 29 recommendations. The council may contract with an independent 30 vendor to conduct the study in accordance with the provisions 20030S0387B1076 - 38 -
1 for selecting vendors in section 16. The study shall include, 2 but not be limited to, the following: 3 (1) the number and characteristics of the medically 4 indigent population, including such factors as income, 5 employment status, health status, patterns of health care 6 utilization, type of health care needed and utilized, 7 eligibility for health care insurance, distribution of this 8 population on a geographic basis and by age, sex and racial 9 or linguistic characteristics, and the changes in these 10 characteristics, including the following: 11 (i) the needs and problems of indigent persons in 12 urban areas; 13 (ii) the needs and problems of indigent persons in 14 rural areas; 15 (iii) the needs and problems of indigent persons who 16 are members of racial or linguistic minorities; 17 (iv) the needs and problems of indigent persons in 18 areas of high unemployment; and 19 (v) the needs and problems of the underinsured; 20 (2) the degree of and any change in access of this 21 population to sources of health care, including hospitals, 22 physicians and other providers; 23 (3) the distribution and means of financing indigent 24 care between and among providers, insurers, government, 25 purchasers and consumers, and the effect of that distribution 26 on each; 27 (4) the major types of care rendered to the indigent, 28 the setting in which each type of care is rendered and the 29 need for additional care of each type by the indigent; 30 (5) the likely impact of changes in the health delivery 20030S0387B1076 - 39 -
1 system, including managed care entities, and the effects of 2 cost containment in the Commonwealth on the access to, 3 availability of and financing of needed care for the 4 indigent, including the impact on providers which provide a 5 disproportionate amount of care to the indigent; 6 (6) the distribution of delivered care and actual cost 7 to render such care by provider, region and subregion; 8 (7) the provision of care to the indigent through 9 improvements in the primary health care system, including the 10 management of needed hospital care by primary care providers; 11 (8) innovative means to finance and deliver care to the 12 medically indigent; and 13 (9) reduction in the dependence of indigent persons on 14 hospital services through improvements in preventive health 15 measures. 16 Section 4. Sections 9 and 10 of the act are reenacted and 17 amended to read: 18 Section 9. Mandated health benefits. 19 In relation to current law or proposed legislation, the 20 council shall, upon the request of the appropriate committee 21 chairman in the Senate and in the House of Representatives or 22 upon the request of the Secretary of Health, provide information 23 on the proposed mandated health benefit pursuant to the 24 following: 25 (1) The General Assembly hereby declares that proposals 26 for mandated health benefits or mandated health insurance 27 coverage should be accompanied by adequate, independently 28 certified documentation defining the social and financial 29 impact and medical efficacy of the proposal. To that end the 30 council, upon receipt of such requests, is hereby authorized 20030S0387B1076 - 40 -
1 to conduct a preliminary review of the material submitted by 2 both proponents and opponents concerning the proposed 3 mandated benefit. If, after this preliminary review, the 4 council is satisfied that both proponents and opponents have 5 submitted sufficient documentation necessary for a review 6 pursuant to paragraphs (3) and (4), the council is directed 7 to contract with individuals, pursuant to the selection 8 procedures for vendors set forth in section 16, who will 9 constitute a Mandated Benefits Review Panel to review 10 mandated benefits proposals and provide independently 11 certified documentation, as provided for in this section. 12 (2) The panel shall consist of [four] senior <-- 13 researchers, each of whom shall be a recognized expert: 14 (i) one in health research; 15 (ii) one in biostatistics; 16 (iii) one in economic research; [and] 17 (iv) one, a physician, in the appropriate specialty 18 with current knowledge of the subject being proposed as a 19 mandated benefit; and 20 (v) one with experience in insurance or actuarial 21 research. 22 (3) The Mandated Benefits Review Panel shall have the 23 following duties and responsibilities: 24 (i) To review documentation submitted by persons 25 proposing or opposing mandated benefits within 90 days of 26 submission of said documentation to the panel. 27 (ii) To report to the council, pursuant to its 28 review in subparagraph (i), the following: 29 (A) Whether or not the documentation is complete 30 as defined in paragraph (4). 20030S0387B1076 - 41 -
1 (B) Whether or not the research cited in the 2 documentation meets professional standards. 3 (C) Whether or not all relevant research 4 respecting the proposed mandated benefit has been 5 cited in the documentation. 6 (D) Whether or not the conclusions and 7 interpretations in the documentation are consistent 8 with the data submitted. 9 (4) To provide the Mandated Benefits Review Panel with 10 sufficient information to carry out its duties and 11 responsibilities pursuant to paragraph (3), persons proposing 12 or opposing legislation mandating benefits coverage should 13 submit documentation to the council, pursuant to the 14 procedure established in paragraph (5), which demonstrates 15 the following: 16 (i) The extent to which the proposed benefit and the 17 services it would provide are needed by, available to and 18 utilized by the population of the Commonwealth. 19 (ii) The extent to which insurance coverage for the 20 proposed benefit already exists, or if no such coverage 21 exists, the extent to which this lack of coverage results 22 in inadequate health care or financial hardship for the 23 population of the Commonwealth. 24 (iii) The demand for the proposed benefit from the 25 public and the source and extent of opposition to 26 mandating the benefit. 27 (iv) All relevant findings bearing on the social 28 impact of the lack of the proposed benefit. 29 (v) Where the proposed benefit would mandate 30 coverage of a particular therapy, the results of at least 20030S0387B1076 - 42 -
1 one professionally accepted, controlled trial comparing 2 the medical consequences of the proposed therapy, 3 alternative therapies and no therapy. 4 (vi) Where the proposed benefit would mandate 5 coverage of an additional class of practitioners, the 6 results of at least one professionally accepted, 7 controlled trial comparing the medical results achieved 8 by the additional class of practitioners and those 9 practitioners already covered by benefits. 10 (vii) The results of any other relevant research. 11 (viii) Evidence of the financial impact of the 12 proposed legislation, including at least: 13 (A) The extent to which the proposed benefit 14 would increase or decrease cost for treatment or 15 service. 16 (B) The extent to which similar mandated 17 benefits in other states have affected charges, costs 18 and payments for services. 19 (C) The extent to which the proposed benefit 20 would increase the appropriate use of the treatment 21 or service. 22 (D) The impact of the proposed benefit on 23 administrative expenses of health care insurers. 24 (E) The impact of the proposed benefits on 25 benefits costs of purchasers. 26 (F) The impact of the proposed benefits on the 27 total cost of health care within the Commonwealth. 28 (5) The procedure for review of documentation is as 29 follows: 30 (i) Any person wishing to submit information on 20030S0387B1076 - 43 -
1 proposed legislation mandating insurance benefits for 2 review by the panel should submit the documentation 3 specified in paragraph (4) to the council. 4 (ii) The council shall, within 30 days of receipt of 5 the documentation: 6 (A) Publish in the Pennsylvania Bulletin notice 7 of receipt of the documentation, a description of the 8 proposed legislation, provision for a period of 60 9 days for public comment and the time and place at 10 which any person may examine the documentation. 11 (B) Submit copies of the documentation to the 12 Secretary of Health and the Insurance Commissioner, 13 who shall review and submit comments to the council 14 on the proposed legislation within 30 days. 15 (C) Submit copies of the documentation to the 16 panel, which shall review the documentation and issue 17 their findings, pursuant to paragraph (3), within 90 18 days. 19 (iii) Upon receipt of the comments of the Secretary 20 of Health and the Insurance Commissioner and of the 21 findings of the panel, pursuant to subparagraph (ii), but 22 no later than 120 days following the publication required 23 in subparagraph (ii), the council shall submit said 24 comments and findings, together with its recommendations 25 respecting the proposed legislation, to the Governor, the 26 President pro tempore of the Senate, the Speaker of the 27 House of Representatives, the Secretary of Health, the 28 Insurance Commissioner and the person who submitted the 29 information pursuant to subparagraph (i). 30 Section 10. Access to council data. 20030S0387B1076 - 44 -
1 (a) Public access.--The information and data received by the 2 council shall be utilized by the council for the benefit of the 3 public and public officials. Subject to the specific limitations 4 set forth in this section, the council shall make determinations 5 on requests for information in favor of access. 6 (a.1) Outreach programs.--The council shall develop and 7 implement outreach programs designed to make its information 8 understandable and usable to purchasers, providers, other 9 Commonwealth agencies and the general public. The programs shall 10 include efforts to educate through pamphlets, booklets, seminars 11 and other appropriate measures and to facilitate making more 12 informed health care choices. 13 (b) Limitations on access.--Unless specifically provided for 14 in this act, neither the council nor any contracting system 15 vendor shall release and no data source, person, member of the 16 public or other user of any data of the council shall gain 17 access to: 18 (1) Any raw data of the council that does not 19 simultaneously disclose payment, as well as provider quality 20 and provider service effectiveness pursuant to sections 21 5(d)(4) and 6(d) or 7(a)(1)(iii). 22 (2) Any raw data of the council which could reasonably 23 be expected to reveal the identity of an individual patient. 24 (3) Any raw data of the council which could reasonably 25 be expected to reveal the identity of any purchaser, as 26 defined in section 3, other than a purchaser requesting data 27 on its own group or an entity entitled to said purchaser's 28 data pursuant to subsection (f). 29 (4) Any raw data of the council relating to actual 30 payments to any identified provider made by any purchaser, 20030S0387B1076 - 45 -
1 except that this provision shall not apply to access by a 2 purchaser requesting data on the group for which it purchases 3 or otherwise provides covered services or to access to that 4 same data by an entity entitled to the purchaser's data 5 pursuant to subsection (f). 6 (5) Any raw data disclosing discounts or differentials 7 between payments accepted by providers for services and their 8 billed charges obtained by identified payors from identified 9 providers unless [comparable data on all other payors is also 10 released] the data is released in a Statewide, aggregate 11 format that does not identify any individual payor or class 12 of payors and the council [determines] assures that the 13 release of such information is not prejudicial or inequitable 14 to any individual payor or provider or group thereof. [In 15 making such determination the council shall consider that it 16 is primarily concerned with the analysis and dissemination of 17 payments to providers, not with discounts.] 18 (c) Unauthorized use of data.--Any person who knowingly 19 releases council data violating the patient confidentiality, 20 actual payments, discount data or raw data safeguards set forth 21 in this section to an unauthorized person commits a misdemeanor 22 of the first degree and shall, upon conviction, be sentenced to 23 pay a fine of $10,000 or to imprisonment for not more than five 24 years, or both. An unauthorized person who knowingly receives or 25 possesses such data commits a misdemeanor of the first degree. 26 (d) Unauthorized access to data.--Should any person 27 inadvertently or by council error gain access to data that 28 violates the safeguards set forth in this section, the data must 29 immediately be returned, without duplication, to the council 30 with proper notification. 20030S0387B1076 - 46 -
1 (e) Public access to records.--All public reports prepared 2 by the council shall be public records and shall be available to 3 the public for a reasonable fee, and copies shall be provided, 4 upon request of the chair, to the Public Health and Welfare 5 Committee of the Senate and the Health and Welfare Committee of 6 the House of Representatives. 7 (f) Access to raw council data by purchasers.--Pursuant to 8 sections 5(d)(5) and 7(b) and subject to the limitations on 9 access set forth in subsection (b), the council shall provide 10 access to its raw data to purchasers in accordance with the 11 following procedure: 12 (1) Special reports derived from raw data of the council 13 shall be provided by the council to any purchaser requesting 14 such reports. 15 (2) A means to enable computer-to-computer access by any 16 purchaser to raw data of the council as defined in section 3 17 shall be developed, adopted and implemented by the council, 18 and the council shall provide such access to its raw data to 19 any purchaser upon request. 20 (3) In the event that any employer obtains from the 21 council, pursuant to paragraph (1) or (2), data pertaining to 22 its employees and their dependents for whom said employer 23 purchases or otherwise provides covered services as defined 24 in section 3 and who are represented by a certified 25 collective bargaining representative, said collective 26 bargaining representative shall be entitled to that same 27 data, after payment of fees as specified in paragraph (4). 28 Likewise, should a certified collective bargaining 29 representative obtain from the council, pursuant to paragraph 30 (1) or (2), data pertaining to its members and their 20030S0387B1076 - 47 -
1 dependents who are employed by and for whom covered services 2 are purchased or otherwise provided by any employer, said 3 employer shall be entitled to that same data, after payment 4 of fees as specified in paragraph (4). 5 (4) In providing for access to its raw data, the council 6 shall charge the purchasers which originally obtained such 7 access a fee sufficient to cover its costs to prepare and 8 provide special reports requested pursuant to paragraph (1) 9 or to provide computer-to-computer access to its raw data 10 requested pursuant to paragraph (2). Should a second or 11 subsequent party or parties request this same information 12 pursuant to paragraph (3), the council shall charge said 13 party a reasonable fee. 14 (g) Access to raw council data by other parties.--Subject to 15 the limitations on access to raw council data set forth in 16 subsection (b), the council may, at its discretion, provide 17 special reports derived from its raw data or computer-to- 18 computer access to parties other than purchasers. The council 19 shall publish regulations that set forth the criteria and the 20 procedure it shall use in making determinations on such access, 21 pursuant to the powers vested in the council in section 4. In 22 providing such access, the council shall charge the party 23 requesting the access a reasonable fee. 24 Section 5. Section 11 of the act is reenacted to read: 25 Section 11. Special studies and reports. 26 (a) Special studies.--Any Commonwealth agency may publish or 27 contract for publication of special studies. Any special study 28 so published shall become a public document. 29 (b) Special reports.-- 30 (1) Any Commonwealth agency may study and issue a report 20030S0387B1076 - 48 -
1 on the special medical needs, demographic characteristics, 2 access or lack thereof to health care services and need for 3 financing of health care services of: 4 (i) Senior citizens, particularly low-income senior 5 citizens, senior citizens who are members of minority 6 groups and senior citizens residing in low-income urban 7 or rural areas. 8 (ii) Low-income urban or rural areas. 9 (iii) Minority communities. 10 (iv) Women. 11 (v) Children. 12 (vi) Unemployed workers. 13 (vii) Veterans. 14 The reports shall include information on the current 15 availability of services to these targeted parts of the 16 population, and whether access to such services has increased 17 or decreased over the past ten years, and specific 18 recommendations for the improvement of their primary care and 19 health delivery systems, including disease prevention and 20 comprehensive health care services. The department may also 21 study and report on the effects of using prepaid, capitated 22 or HMO health delivery systems as ways to promote the 23 delivery of primary health care services to the underserved 24 segments of the population enumerated above. 25 (2) The department may study and report on the short- 26 term and long-term fiscal and programmatic impact on the 27 health care consumer of changes in ownership of hospitals 28 from nonprofit to profit, whether through purchase, merger or 29 the like. The department may also study and report on factors 30 which have the effect of either reducing provider revenue or 20030S0387B1076 - 49 -
1 increasing provider cost, and other factors beyond a 2 provider's control which reduce provider competitiveness in 3 the marketplace, are explained in the reports. 4 Section 6. Section 12 of the act is reenacted and amended to 5 read: 6 Section 12. Enforcement; penalty. 7 (a) Compliance enforcement.--The council shall have standing 8 to bring an action in law or in equity through private counsel 9 in any court of common pleas to enforce compliance with any 10 provision of this act, except section 11, or any requirement or 11 appropriate request of the council made pursuant to this act. In 12 addition, the Attorney General is authorized and shall bring any 13 such enforcement action in aid of the council in any court of 14 common pleas at the request of the council in the name of the 15 Commonwealth. 16 (b) Penalty.-- 17 (1) Any person who fails to supply data pursuant to 18 section 6 [commits a misdemeanor of the third degree and 19 shall, upon conviction, be sentenced to pay a fine not to 20 exceed $1,000. Each day on which the required data is not 21 submitted constitutes a separate offense under this 22 paragraph.] shall MAY be assessed a civil penalty not to <-- 23 exceed $1,000 for each day the data is not submitted. 24 (2) [Any person who, after being sentenced under 25 paragraph (1), fails to supply data pursuant to section 6 26 commits a misdemeanor of the third degree and shall, upon 27 conviction, be sentenced to pay a fine of $10,000 or to 28 imprisonment for not more than five years, or both.] Any 29 person who knowingly submits inaccurate data under section 6 30 commits a misdemeanor of the third degree and shall, upon 20030S0387B1076 - 50 -
1 conviction, be sentenced to pay a fine of $1,000 or to 2 imprisonment for not more than one year, or both. 3 Section 7. Sections 13, 14, 15, 16, 17.1 and 18 of the act 4 are reenacted to read: 5 Section 13. Research and demonstration projects. 6 The council shall actively encourage research and 7 demonstrations to design and test improved methods of assessing 8 provider quality, provider service effectiveness and efficiency. 9 To that end, provided that no data submission requirements in a 10 mandated demonstration may exceed the current reserve field on 11 the Pennsylvania Uniform Claims and Billing Form, the council 12 may: 13 (1) Authorize contractors engaged in health services 14 research selected by the council, pursuant to the provisions 15 of section 16, to have access to the council's raw data 16 files, providing such entities assume any contractual 17 obligations imposed by the council to assure patient identity 18 confidentiality. 19 (2) Place data sources participating in research and 20 demonstrations on different data submission requirements from 21 other data sources in this Commonwealth. 22 (3) Require data source participation in research and 23 demonstration projects when this is the only testing method 24 the council determines is promising. 25 Section 14. Grievances and grievance procedures. 26 (a) Procedures and requirements.--Pursuant to its powers to 27 publish regulations under section 5(b) and with the requirements 28 of this section, the council is hereby authorized and directed 29 to establish procedures and requirements for the filing, hearing 30 and adjudication of grievances against the council of any data 20030S0387B1076 - 51 -
1 source. Such procedures and requirements shall be published in 2 the Pennsylvania Bulletin pursuant to law. 3 (b) Claims; hearings.--Grievance claims of any data source 4 shall be submitted to the council or to a third party designated 5 by the council, and the council or the designated third party 6 shall convene a hearing, if requested, and adjudicate the 7 grievance. 8 Section 15. Antitrust provisions. 9 Persons or entities required to submit data or information 10 under this act or receiving data or information from the council 11 in accordance with this act are declared to be acting pursuant 12 to State requirements embodied in this act and shall be exempt 13 from antitrust claims or actions grounded upon submission or 14 receipt of such data or information. 15 Section 16. Contracts with vendors. 16 Any contract with any vendor other than a sole source vendor 17 for purchase of services or for purchase or lease of supplies 18 and equipment related to the council's powers and duties shall 19 be let only after a public bidding process and only in 20 accordance with the following provisions, and no contract shall 21 be let by the council that does not conform to these provisions: 22 (1) The council shall prepare specifications fully 23 describing the services to be rendered or equipment or 24 supplies to be provided by a vendor and shall make these 25 specifications available for inspection by any person at the 26 council's offices during normal working hours and at such 27 other places and such other times as the council deems 28 advisable. 29 (2) The council shall publish notice of invitations to 30 bid in the Pennsylvania Bulletin. The council shall also 20030S0387B1076 - 52 -
1 publish such notice in at least four newspapers in general 2 circulation in the Commonwealth on at least three occasions 3 at intervals of not less than three days. Said notice shall 4 include at least the following: 5 (i) The deadline for submission of bids by 6 prospective vendors, which shall be no sooner than 30 7 days following the latest publication of the notice as 8 prescribed in this paragraph. 9 (ii) The locations, dates and times during which 10 prospective vendors can examine the specifications 11 required in paragraph (1). 12 (iii) The date, time and place of the meeting or 13 meetings of the council at which bids will be opened and 14 accepted. 15 (iv) A statement to the effect that any person is 16 eligible to bid. 17 (3) Bids shall be accepted as follows: 18 (i) No council member who is affiliated in any way 19 with any bidder shall vote on the awarding of any 20 contract for which said bidder has submitted a bid, and 21 any council member who has an affiliation with a bidder 22 shall state the nature of the affiliation prior to any 23 vote of the council. 24 (ii) Bids shall be opened and reviewed by the 25 appropriate council committee, which shall make 26 recommendations to the council on approval. Bids shall be 27 accepted and such acceptance shall be announced only at a 28 public meeting of the council as defined in section 4(e), 29 and no bids shall be accepted at an executive session of 30 the council. 20030S0387B1076 - 53 -
1 (iii) The council may require that a certified 2 check, in an amount determined by the council, accompany 3 every bid, and, when so required, no bid shall be 4 accepted unless so accompanied. 5 (4) In order to prevent any party from deliberately 6 underbidding contracts in order to gain or prevent access to 7 council data, the council may award any contract at its 8 discretion, regardless of the amount of the bid, pursuant to 9 the following: 10 (i) Any bid accepted must reasonably reflect the 11 actual cost of services provided. 12 (ii) Any vendor so selected by the council shall be 13 found by the council to be of such character and such 14 integrity as to assure, to the maximum extent possible, 15 adherence to all the provisions of this act in the 16 provision of contracted services. 17 (iii) The council may require the selected vendor to 18 furnish, within 20 days after the contract has been 19 awarded, a bond with suitable and reasonable requirements 20 guaranteeing the services to be performed with sufficient 21 surety in an amount determined by the council, and upon 22 failure to furnish such bond within the time specified, 23 the previous award shall be void. 24 (5) The council shall make efforts to assure that its 25 vendors have established affirmative action plans to assure 26 equal opportunity policies for hiring and promoting 27 employees. 28 Section 17.1. Reporting. 29 The council shall provide an annual report of its financial 30 expenditures to the Appropriations Committee of the Senate and 20030S0387B1076 - 54 -
1 the Appropriations Committee of the House of Representatives. 2 Section 18. Severability. 3 The provisions of this act are severable. If any provision of 4 this act or its application to any person or circumstance is 5 held invalid, the invalidity shall not affect other provisions 6 or applications of this act which can be given effect without 7 the invalid provision or application. 8 Section 8. Section 19 of the act is reenacted and amended to 9 read: 10 Section 19. Sunset. 11 This act shall expire June 30, [2003] 2008, unless reenacted 12 prior to [that date.] September 1, 2007. By March BY SEPTEMBER <-- 13 1, 2007, a written report by the Legislative Budget and Finance 14 Committee evaluating the management, visibility, awareness and 15 performance of the council shall be provided to the Public 16 Health and Welfare Committee of the Senate and the Health and 17 Human Services Committee of the House of Representatives. The 18 report shall include a review of the council's procedures and 19 policies, the availability and quality of data for completing 20 reports to hospitals and outside vendor purchasers; the ability 21 of the council to become self-sufficient by selling data to 22 outside purchasers; whether there is a more cost-efficient way 23 of accomplishing the objectives of the council and the need for 24 reauthorization of the council. 25 Section 9. Section 20 of the act is reenacted to read: 26 Section 20. Effective date. 27 This act shall take effect immediately. 28 SECTION 9.1. IN ACCORDANCE WITH SECTION 10 OF THIS ACT, THE <-- 29 FOLLOWING APPLY TO THE PERIOD FROM JUNE 30, 2003, TO THE DAY 30 PRIOR TO THE EFFECTIVE DATE OF THIS SECTION: 20030S0387B1076 - 55 -
1 (1) THERE IS NO LAPSE IN MEMBERSHIP ON THE HEALTH CARE 2 COST CONTAINMENT COUNCIL. 3 (2) ELEVEN MEMBERS CONSTITUTE A QUORUM. 4 (3) ANY ACTION TAKEN BY THE COUNCIL IS VALIDATED. 5 (4) THERE SHALL BE NO LAPSE IN THE EMPLOYMENT 6 RELATIONSHIP FOR EMPLOYEES OF THE COUNCIL. THIS PARAGRAPH 7 INCLUDES SALARY, SENIORITY, BENEFITS AND RETIREMENT 8 ELIGIBILITY OF THE EMPLOYEES. 9 SECTION 9.2. NEW POSITIONS ON THE COUNCIL CREATED UNDER THIS 10 ACT SHALL BE FILLED IN THE MANNER DESIGNATED UNDER SECTION 4(B) 11 OF THE ACT NO LATER THAN 60 DAYS AFTER THE EFFECTIVE DATE OF 12 THIS ACT. ORGANIZATIONS REQUIRED UNDER SECTION 4(B) OF THE ACT 13 TO SUBMIT LISTS OF RECOMMENDED PERSONS TO FILL NEW POSITIONS ON 14 THE COUNCIL SHALL DO SO NO LATER THAN 30 DAYS AFTER THE 15 EFFECTIVE DATE OF THIS ACT. 16 Section 10. This act shall apply retroactively to June 29, 17 2003. 18 Section 11. This act shall take effect immediately. A23L35SFL/20030S0387B1076 - 56 -