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                                                      PRINTER'S NO. 1011

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 700 Session of 2007


        INTRODUCED BY EACHUS, DeLUCA, DeWEESE, McCALL, D. EVANS, COHEN,
           DERMODY, SURRA, STURLA, OLIVER AND MUNDY, MARCH 22, 2007

        REFERRED TO COMMITTEE ON INSURANCE, MARCH 22, 2007

                                     AN ACT

     1  Amending Title 40 (Insurance) of the Pennsylvania Consolidated
     2     Statutes, reforming the health care system by providing for
     3     access to affordable health insurance coverage for previously
     4     uninsured individuals and for small businesses, ensuring that
     5     charitable health care institutions meet their community
     6     benefit requirements, strengthening Commonwealth oversight of
     7     health insurance rate increases, imposing certain duties on
     8     retail drug stores, hospitals and certain outpatient
     9     facilities to report price information, establishing the
    10     Pennsylvania Center for Health Careers and the Health Careers
    11     Leadership Council, removing barriers to individual health
    12     care providers from practicing to the full extent of their
    13     scope of practice, education and training, imposing certain
    14     health information technology requirements on health care
    15     providers, imposing patient safety obligations on hospitals
    16     and nursing homes, prohibiting smoking in areas open to the
    17     public, food service establishments and places of employment,
    18     providing for administration, imposing penalties and making
    19     repeals.

    20     The General Assembly of the Commonwealth of Pennsylvania
    21  hereby enacts as follows:
    22     Section 1.  Title 40 of the Pennsylvania Consolidated
    23  Statutes is amended by adding a part to read:
    24                             SUBPART IV
    25                         HEALTH CARE REFORM
    26  Chapter


     1    71.  General Provisions
     2    72.  Affordability
     3    73.  Accessibility
     4    74.  Quality of Care and Healthy Lifestyles
     5    75.  Miscellaneous Provisions
     6                             CHAPTER 71
     7                         GENERAL PROVISIONS
     8  Sec.
     9  7101.  Scope and short title.
    10  7102.  Legislative intent.
    11  7103.  Definitions.
    12  § 7101.  Scope and short title.
    13     This part relates to health care reform and shall be known
    14  and may be cited as the Pennsylvania Health Care Reform Act.
    15  § 7102.  Legislative intent.
    16     The General Assembly recognizes the following public policy
    17  purposes and declares that the following objectives of this
    18  Commonwealth are to be served by this part:
    19         (1)  Health care costs have been increasing twice as fast
    20     as average wages in this Commonwealth. Yet at the same time
    21     as health care costs are skyrocketing and nearly one million
    22     Pennsylvanians remain uninsured, the Commonwealth is paying
    23     billions of dollars each year in avoidable health care costs.
    24         (2)  The large number of uninsured workers in this
    25     Commonwealth has a negative impact on the Commonwealth's
    26     economy and productivity because insured workers are
    27     healthier and more productive and use fewer sick days. The
    28     Commonwealth should play a role in making health care
    29     coverage affordable for small businesses and for uninsured
    30     individuals.
    20070H0700B1011                  - 2 -     

     1         (3)  The health care crisis is of national concern, but
     2     it is possible to create a solution in Pennsylvania that
     3     drives down the cost of health care and improves the well-
     4     being of Pennsylvania's citizens by addressing three
     5     fundamental issues: affordability, accessibility and quality.
     6         (4)  The Commonwealth has a clear interest in ensuring
     7     that Pennsylvania families and small employers can afford
     8     health insurance. In addition to the staggering human impact
     9     of inadequate health care, paying for the uninsured drives up
    10     the cost of health care for all insured Pennsylvanians. The
    11     extra charge in insurance premiums resulting from this
    12     amounts to over a billion dollars each year.
    13         (5)  Individual and small group health insurance rates
    14     are volatile. In order to ensure that affordable individual
    15     and small group health insurance is available, the
    16     Commonwealth must do all of the following:
    17             (i)  Contain health care coverage premium increases
    18         for small employers.
    19             (ii)  Spread the risks.
    20             (iii)  Ensure that affordable health care coverage is
    21         available to those who have lost their employer-based
    22         coverage.
    23             (iv)  Ensure that a substantial portion of the
    24         premiums for small employers is used to pay medical
    25         claims.
    26             (v)  Require justification for premium increases.
    27         (6)  The Commonwealth's not-for-profit hospitals receive
    28     tax and other benefits as a result of their classification as
    29     charitable institutions and, in return, are required to
    30     provide a substantial community benefit. However, there is
    20070H0700B1011                  - 3 -     

     1     currently no uniform method of assessing whether a hospital
     2     has met this obligation. Not-for-profit hospitals that enjoy
     3     these benefits must demonstrate how they are meeting their
     4     obligations to the community.
     5         (7)  With regard to quality and price, Pennsylvania's
     6     health care market should be as transparent as possible, so
     7     that all consumers will have the information they need to
     8     make informed decisions on where they can obtain the best
     9     quality health care at the best price.
    10         (8)  To expand access to quality health care, all health
    11     care professionals need to be able to practice to the fullest
    12     extent of their education, training and skills. Pennsylvania
    13     lags behind the rest of the nation in ensuring that nurses,
    14     nurse practitioners, physician assistants and other health
    15     care providers are permitted to play critical roles to
    16     support, coach and treat the patient, resulting in better
    17     outcomes for all Pennsylvanians. Barriers that limit licensed
    18     health care providers from performing up to the fullest
    19     extent of their scope of practice, education and training in
    20     this Commonwealth should be eliminated.
    21         (9)  The unnecessary use of emergency room services in
    22     this Commonwealth affects both the outcome of patient care
    23     and the cost to the entire health care system. Access to
    24     clinics that can function as places where individuals go on a
    25     regular basis to receive health care should be expanded and
    26     Pennsylvanians should be educated about the appropriate use
    27     of emergency rooms and alternative sites of care.
    28         (10)  The primary goals of the Commonwealth's health care
    29     system must be the safety of its patients and the quality of
    30     health care services delivered. In order to further these
    20070H0700B1011                  - 4 -     

     1     goals and to continue to improve the safety of patients,
     2     hospital-acquired infections, which lead to thousands of
     3     unnecessary deaths each year and drive up health care costs,
     4     must be eliminated. Hospitals need to focus on infection and
     5     error trends in their facilities and adopt safe practices and
     6     quality management systems to reduce them. Not only
     7     individual health care providers, but administrators and
     8     boards of directors must be accountable for understanding the
     9     importance of patient safety in reducing risk, improving
    10     quality and reducing the cost of health care.
    11         (11)  Breathing secondhand smoke is a significant health
    12     hazard for nonsmokers. It is in the best interests of the
    13     citizens of this Commonwealth to protect nonsmokers from
    14     involuntary exposure to secondhand tobacco smoke in indoor
    15     areas open to the public, food service establishments and
    16     places of employment. In addition, adults who smoke, are
    17     overweight or inactive are at an increased risk of developing
    18     high blood pressure, type 2 diabetes, heart disease and some
    19     types of cancers and become an economic burden to all health
    20     care payers in this Commonwealth.
    21  § 7103.  Definitions.
    22     The following words and phrases when used in this part shall
    23  have the meanings given to them in this section unless the
    24  context clearly indicates otherwise:
    25     "Accident and Health Filing Reform Act."  The act of December
    26  18, 1996 (P.L.1066, No.159), known as the Accident and Health
    27  Filing Reform Act.
    28     "Ambulatory surgical facility."  An entity licensed as an
    29  ambulatory surgical facility under the act of July 19, 1979
    30  (P.L.130, No.48), known as the Health Care Facilities Act.
    20070H0700B1011                  - 5 -     

     1     "Behavioral health services."  Mental health or substance
     2  abuse services.
     3     "Birth center."  An entity licensed as a birth center under
     4  the act of July 19, 1979 (P.L.130, No.48), known as the Health
     5  Care Facilities Act.
     6     "CAP" or "Cover All Pennsylvanians."  The health insurance
     7  program established under section 7202 (relating to Cover All
     8  Pennsylvanians health insurance program).
     9     "CAP Fund."  The restricted account established under section
    10  7202 (relating to Cover All Pennsylvanians health insurance
    11  program).
    12     "Children's Health Care Program" or "CHIP."  The Children's
    13  Health Care Program established under Article XXIII of the act
    14  of May 17, 1921 (P.L.682, No.284), known as The Insurance
    15  Company Law of 1921.
    16     "Commonwealth Attorneys Act."  The act of October 15, 1980
    17  (P.L.950, No.164), known as the Commonwealth Attorneys Act.
    18     "Commonwealth Documents Law."  The act of July 31, 1968
    19  (P.L.769, No.240), referred to as the Commonwealth Documents
    20  Law.
    21     "Council."  The Health Care Cost Containment Council
    22  established under the act of July 8, 1986 (P.L.408, No.89),
    23  known as the Health Care Cost Containment Act.
    24     "Employer."  The term shall include:
    25         (1)  Any of the following who or which employ one or more
    26     employees to perform services for remuneration for any period
    27     of time:
    28             (i)  An individual, copartnership, association,
    29         domestic or foreign corporation or other entity.
    30             (ii)  The legal representative, trustee in
    20070H0700B1011                  - 6 -     

     1         bankruptcy, receiver or trustee of any individual,
     2         copartnership, association or corporation or other
     3         entity.
     4             (iii)  The legal representative of a deceased
     5         individual.
     6         (2)  Individuals who are self-employed.
     7         (3)  The executive, legislative and judicial branches of
     8     the Commonwealth and any of its political subdivisions.
     9     "Fiscal year."  A period of 12 consecutive calendar months
    10  commencing with July 1.
    11     "Health Care Cost Containment Act."  The act of July 8, 1986
    12  (P.L.408, No.89), known as the Health Care Cost Containment Act.
    13     "Health Care Facilities Act."  The act of July 19, 1979
    14  (P.L.130, No.48), known as the Health Care Facilities Act.
    15     "Health care facility."  An ambulatory surgical facility,
    16  birth center, hospital or nursing home.
    17     "Health care provider."  Any of the following:
    18         (1)  A licensee.
    19         (2)  A health care facility.
    20         (3)  An officer, employee or agent of any of the entities
    21     under paragraph (1) or (2) acting in the course and scope of
    22     employment.
    23     "Hospital."  An entity licensed as an acute-care general
    24  hospital, a specialty hospital or rehabilitation hospital under
    25  the act of July 19, 1979 (P.L.130, No.48), known as the Health
    26  Care Facilities Act.
    27     "Institutions of Purely Public Charity Act."  The act of
    28  November 26, 1997 (P.L.508, No.55), known as the Institutions of
    29  Purely Public Charity Act.
    30     "Insurer."  A company or health insurance entity licensed in
    20070H0700B1011                  - 7 -     

     1  this Commonwealth to issue any individual or group health,
     2  sickness or accident policy or subscriber contract or
     3  certificate or plan that provides medical or health care
     4  coverage by a health care facility or licensed health care
     5  provider that is offered or governed under the act of May 17,
     6  1921 (P.L.682, No.284), known as The Insurance Company Law of
     7  1921, or any of the following:
     8         (1)  The act of December 29, 1972 (P.L.1701, No.364),
     9     known as the Health Maintenance Organization Act.
    10         (2)  The act of May 18, 1976 (P.L.123, No.54), known as
    11     the Individual Accident and Sickness Insurance Minimum
    12     Standards Act.
    13         (3)  Chapter 61 (relating to hospital plan corporations)
    14     or 63 (relating to professional health services plan
    15     corporations).
    16         (4)  Section 630 of The Insurance Company Law of 1921.
    17         (5)  Sections 2401 through 2466 of The Insurance Company
    18     Law of 1921.
    19     "Licensee."  An individual who is licensed by the Department
    20  of State to provide professional health care services in this
    21  Commonwealth.
    22     "Mcare."  The act of March 20, 2002 (P.L.154, No.13), known
    23  as the Medical Care Availability and Reduction of Error (Mcare)
    24  Act.
    25     "Medical assistance."  The program of medical assistance
    26  established under the act of June 13, 1967 (P.L.31, No.21),
    27  known as the Public Welfare Code.
    28     "Medicare."  The Federal program established under Title
    29  XVIII of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1395
    30  et seq.).
    20070H0700B1011                  - 8 -     

     1     "Nursing home."  An entity licensed as a long-term care
     2  nursing facility under the act of July 19, 1979 (P.L.130,
     3  No.48), known as the Health Care Facilities Act.
     4     "PACE."  The Pharmaceutical Assistance Contract for the
     5  Elderly established under the act of August 26, 1971 (P.L.351,
     6  No.91), known as the State Lottery Law.
     7     "Prevailing Wage Act."  The act of August 15, 1961 (P.L.987,
     8  No.442), known as the Pennsylvania Prevailing Wage Act.
     9     "Public Welfare Code."  The act of June 13, 1967 (P.L.31,
    10  No.21), known as the Public Welfare Code.
    11     "Regulatory Review Act."  The act of June 25, 1982 (P.L.633,
    12  No.181), known as the Regulatory Review Act.
    13     "Tax Reform Code."  The act of March 4, 1971 (P.L.6, No.2),
    14  known as the Tax Reform Code of 1971.
    15     "Tobacco Settlement Act."  The act of June 26, 2001 (P.L.755,
    16  No.77), known as the Tobacco Settlement Act.
    17     "Unemployment Compensation Law."  The act of December 5, 1936
    18  (2nd Sp.Sess., 1936 P.L.2897, No.1), known as the Unemployment
    19  Compensation Law.
    20                             CHAPTER 72
    21                           AFFORDABILITY
    22  Sec.
    23  7201.  Definitions.
    24  7202.  Cover All Pennsylvanians health insurance program.
    25  7203.  Fair share tax.
    26  7204.  Health insurance rate increases and standard plans.
    27  7205.  Health insurance coverage for full-time students.
    28  7206.  Health insurance coverage for certain children of insured
    29         parents.
    30  7207.  Hospital community benefit requirements.
    20070H0700B1011                  - 9 -     

     1  7208.  Uniform admission and fair billing and collection
     2             practices.
     3  7209.  Transparency in price and quality for consumers.
     4  § 7201.  Definitions.
     5     The following words and phrases, when used in this chapter,
     6  shall have the meanings given to them in this section unless the
     7  context clearly indicates otherwise:
     8     "AdultBasic."  The health investment insurance program
     9  established under Chapter 13 of the Tobacco Settlement Act.
    10     "Average annual wage."  The total annual wages paid by an
    11  employer divided by the number of the employer's employees.
    12     "Basic benefit package."  The minimum health benefit
    13  insurance plan determined by the Insurance Commissioner under
    14  section 7202 (relating to Cover All Pennsylvanians health
    15  insurance program).
    16     "CAP contracts."  The contracts entered into under section
    17  7202 (relating to Cover All Pennsylvanians health insurance
    18  program).
    19     "Charitable institution."  A hospital that possesses an
    20  exemption from tax under Article II of the Tax Reform Code
    21  because it meets the criteria for being an institution of purely
    22  public charity as set forth in section 5 of the Institutions of
    23  Purely Public Charity Act.
    24     "Chronic care model."  A model based on the redesign of
    25  health care delivery so that patients, who are supported by a
    26  health care team, play an active role in their care and so that
    27  there is an infrastructure to ensure compliance with established
    28  practice guidelines. The model includes the following six
    29  components:
    30         (1)  Providing patients with chronic conditions support
    20070H0700B1011                 - 10 -     

     1     and information so they can effectively manage their health.
     2         (2)  Ensuring that treatment decisions by health care
     3     providers are based on evidence-based medicine.
     4         (3)  Ensuring that the patients get the care needed by
     5     clarifying roles and tasks and ensuring that all who take
     6     care of patients have centralized, up-to-date information
     7     about the patient and that follow-up care is provided as a
     8     standard procedure.
     9         (4)  Creating and maintaining a patient registry which is
    10     the clinical information system that is the foundation for
    11     successful integration of all the components of the model
    12     because it permits tracking of individual patients and a
    13     population of patients and helps guide the course of
    14     treatment, anticipate problems and track problems.
    15         (5)  Engaging the entire organization in the chronic care
    16     improvement effort.
    17         (6)  Forming alliances with state, local, business,
    18     religious and other organizations to support or expand care
    19     for those with chronic disease.
    20     "Chronic disease."  A disease that is long lasting or
    21  recurrent, does not resolve spontaneously and is rarely
    22  completely cured.
    23     "Commissioner."  The Insurance Commissioner of the
    24  Commonwealth.
    25     "Commonwealth average annual wage."  The average annual wage
    26  in this Commonwealth for a calendar year determined by the
    27  Department of Labor and Industry under section 404(e)(2) of the
    28  Unemployment Compensation Law.
    29     "Community benefit."  The community service requirement of an
    30  institution of purely public charity under the Institutions of
    20070H0700B1011                 - 11 -     

     1  Purely Public Charity Act.
     2     "Community Health Reinvestment Agreement."  The Agreement on
     3  Community Health Reinvestment entered into February 2, 2005, by
     4  the Insurance Department and Capital BlueCross, Highmark Inc.,
     5  Hospital Service Association of Northeastern Pennsylvania and
     6  Independence Blue Cross and published in the Pennsylvania
     7  Bulletin at 35 Pa.B. 4155 (July 23, 2005).
     8     "Contractor."  A person with whom the Insurance Department
     9  has entered into a contract for the purposes of section 7202
    10  (relating to Cover All Pennsylvanians health insurance program).
    11     "Department."  The Insurance Department of the Commonwealth.
    12     "Drug price registry."  The Pennsylvania Drug Retail Price
    13  Registry established by the council under section 7209 (relating
    14  to transparency in price and quality for consumers).
    15     "Eligible employee enrollee."  An individual who is 19 years
    16  of age or older, is an employee of an eligible small low-wage
    17  employer participant and has enrolled in CAP.
    18     "Eligible individual."  As follows:
    19         (1)  An individual who meets all of the following
    20     criteria:
    21             (i)  Is at least 19 years of age but no older than 64
    22         years of age.
    23             (ii)  Has been a resident of this Commonwealth at
    24         least 90 days prior to enrollment in CAP.
    25             (iii)  Is ineligible to receive continuous
    26         eligibility coverage under Title XIX or XXI of the Social
    27         Security Act (49 Stat. 620, 42 U.S.C. § 301 et seq.),
    28         except for benefits authorized under a waiver granted by
    29         the United States Department of Health and Human Services
    30         to implement CAP.
    20070H0700B1011                 - 12 -     

     1             (iv)  Meets one of the following:
     2                 (A)  Is currently enrolled in the health
     3             investment insurance program established under
     4             Chapter 13 of the Tobacco Settlement Act or is wait-
     5             listed for the program on the effective date of this
     6             section.
     7                 (B)  Has a household income that is no greater
     8             than 200% of the Federal poverty level at the time of
     9             application and has not been covered by any health
    10             insurance plan or program for at least 90 days
    11             immediately preceding the date of application, except
    12             that the foregoing 90-day period shall not apply to
    13             an individual who meets one of the following:
    14                     (I)  Is eligible to receive benefits under
    15                 the Unemployment Compensation Law.
    16                     (II)  Was covered under a health insurance
    17                 plan or program provided by an employer but at
    18                 the time of application is no longer covered
    19                 because of a change in the individual's
    20                 employment status and is ineligible to receive
    21                 benefits under the Unemployment Compensation Law.
    22                     (III)  Lost coverage as a result of divorce
    23                 or separation from a covered individual, the
    24                 death of a covered individual or a change in
    25                 employment status of a covered individual.
    26                     (IV)  Is transferring from another
    27                 government-subsidized health insurance program,
    28                 including as a result of failure to meet income
    29                 eligibility requirements.
    30                 (C)  Has a household income that is greater than
    20070H0700B1011                 - 13 -     

     1             200% of the Federal poverty level and has not been
     2             covered by any health insurance plan or program
     3             during the 180 days immediately preceding the date of
     4             application, except that the foregoing 180-day period
     5             shall not apply to an individual who meets one of the
     6             following:
     7                     (I)  Is eligible to receive benefits under
     8                 the Unemployment Compensation Law.
     9                     (II)  Was covered under a health insurance
    10                 plan or program provided by an employer but at
    11                 the time of application is no longer covered
    12                 because of a change in the individual's
    13                 employment status and is ineligible to receive
    14                 benefits under the Unemployment Compensation Law.
    15                     (III)  Lost coverage as a result of divorce
    16                 or separation from a covered individual, the
    17                 death of a covered individual or a change in
    18                 employment status of a covered individual.
    19                     (IV)  Is transferring from another
    20                 government-subsidized health insurance program,
    21                 including as a result of failure to meet income
    22                 eligibility requirements.
    23         (2)  If an individual who otherwise meets the definition
    24     in paragraph (1) is attending an institution of higher
    25     education in this Commonwealth, he shall be required to meet
    26     the domiciliary requirements of 22 Pa. Code Ch. 507 (relating
    27     to finance and administration) prior to enrollment in CAP.
    28     "Eligible individual enrollee."  An eligible individual who
    29  is enrolled in CAP. The term does not include an eligible
    30  employee enrollee.
    20070H0700B1011                 - 14 -     

     1     "Eligible small low-wage employer."  An employer that meets
     2  all of the following:
     3         (1)  Has at least two, but not more than 50 full-time-
     4     equivalent employees.
     5         (2)  Has not offered health care insurance through any
     6     plan or program during the 180 days immediately preceding the
     7     date of application for participation in CAP.
     8         (3)  Pays an average annual wage that is less than the
     9     Commonwealth average annual wage.
    10         (4)  Will enroll in CAP at least 75% of all of its
    11     employees who work 20 hours or more per week.
    12     "Eligible small low-wage employer participant."  An eligible
    13  small low-wage employer who is participating in CAP.
    14     "Employee."  Any individual from whose wages an employer is
    15  required under the Internal Revenue Code of 1986 (Public Law 99-
    16  514, 26 U.S.C. § 1 et seq.) to withhold Federal income tax.
    17     "Enrollee."  An eligible employee enrollee or an eligible
    18  individual enrollee, as the context may require.
    19     "Fair share tax."  The tax imposed under section 7203
    20  (relating to fair share tax).
    21     "Health benefit plan."  An individual or group health
    22  insurance policy, subscriber contract, certificate or plan which
    23  provides health or sickness and accident coverage which is
    24  offered by an insurer. The term shall not include any of the
    25  following:
    26         (1)  An accident only policy.
    27         (2)  A limited benefit policy.
    28         (3)  A credit only policy.
    29         (4)  A long-term or disability income policy.
    30         (5)  A specified disease policy.
    20070H0700B1011                 - 15 -     

     1         (6)  A Medicare supplement policy.
     2         (7)  A Civilian Health and Medical Program of the
     3     Uniformed Services (CHAMPUS) supplement policy.
     4         (8)  A fixed indemnity policy.
     5         (9)  A dental only policy.
     6         (10)  A vision only policy.
     7         (11)  A workers' compensation policy.
     8         (12)  An automobile medical payment policy pursuant to 75
     9     Pa.C.S. (relating to vehicles).
    10     "Hospital payment registry."  The Pennsylvania Hospital
    11  Payment Registry established by the council under section 7209
    12  (relating to transparency in price and quality for consumers).
    13     "Hospital plan corporation."  A not-for-profit corporation
    14  operating under the provisions of Chapter 61 (relating to
    15  hospital plan corporations).
    16     "Imaging center."  An outpatient facility used to assist
    17  health care providers in diagnosis through noninvasive imaging
    18  of internal body organs.
    19     "Individual health benefit plan."  A health benefit plan
    20  offered to an individual.
    21     "Institution of higher education."  A public or private two-
    22  year or four-year college, university or post baccalaureate
    23  program.
    24     "Medical loss ratio."  The ratio of incurred medical claim
    25  costs to earned premiums.
    26     "Offeror."  A hospital plan corporation, professional health
    27  service corporation or other insurer that submits a proposal in
    28  response to the Insurance Department's solicitation of bids or
    29  proposals issued under section 7202 (relating to Cover All
    30  Pennsylvanians health insurance program).
    20070H0700B1011                 - 16 -     

     1     "Outpatient procedure payment registry."  The Pennsylvania
     2  Outpatient Procedure Payment Registry established by the council
     3  under section 7209 (relating to transparency in price and
     4  quality for consumers).
     5     "Patient representative."  An individual designated to act as
     6  the patient's health care agent or health care representative
     7  under 20 Pa.C.S. Ch. 54 (relating to health care) or who has
     8  informed the hospital that he will be financially responsible
     9  for the patient's medical care.
    10     "Preexisting condition."  A disease or physical condition for
    11  which medical advice, diagnosis, care or treatment has been
    12  recommended or received prior to the effective date of coverage.
    13     "Prescription drug."  A controlled substance, other drug or
    14  device for medication dispensed by order of a health care
    15  provider with prescriptive authority under the laws of this
    16  Commonwealth.
    17     "Professional health service plan corporation."  A not-for-
    18  profit corporation operating under the provisions of Chapter 63
    19  (relating to professional health services plan corporations).
    20     "Qualifying health care coverage."  A health benefit plan or
    21  other form of health care coverage that qualifies an employer
    22  for the credit under section 7203 (relating to fair share tax).
    23     "Small employer."  In connection with a group health plan
    24  with respect to a calendar year and a plan year, an employer who
    25  employs an average of at least two but not more than 50
    26  employees on business days during the preceding calendar year
    27  and who employs at least two such employees on the first day of
    28  the plan year. In the case of an employer which was not in
    29  existence throughout the preceding calendar year, the
    30  determination whether an employer is a small employer shall be
    20070H0700B1011                 - 17 -     

     1  based on the average number of employees that it is reasonably
     2  expected that the employer will employ on business days in the
     3  current calendar year.
     4     "Small group health benefit plan."  A health benefit plan
     5  offered to a small employer.
     6     "Standard plan."  One of the health benefit packages
     7  established by the Insurance Department in accordance with
     8  section 7204(d) (relating to health insurance rate increases and
     9  standard plans).
    10     "Wages."  All remuneration, including the cash value of
    11  mediums of payment other than cash, paid by an employer to all
    12  employees for services performed in this Commonwealth, including
    13  amounts withheld from the employees' pay by the employer. The
    14  term shall not include remuneration excluded from wages under
    15  the provisions of the definition of "wages" under section 4(x)
    16  of the Unemployment Compensation Law, other than the provisions
    17  of the definition of "wages" under section 4(x)(1). This
    18  paragraph shall not exclude remuneration included in wages under
    19  the provisions of the definition of "wages" under section
    20  4(x)(6) of the Unemployment Compensation Law.
    21  § 7202.  Cover All Pennsylvanians health insurance program.
    22     (a)  Establishment.--The Cover All Pennsylvanians health
    23  insurance program is established within the department.
    24     (b)  Purpose.--The purpose of CAP is to assist certain small
    25  business employers to cover their uninsured employees and to
    26  provide access to affordable health insurance coverage for
    27  uninsured adult Pennsylvanians.
    28     (c)  Administration.--The department shall administer CAP
    29  under subsection (f)(1).
    30     (d)  CAP Fund.--
    20070H0700B1011                 - 18 -     

     1         (1)  There is established a restricted account in the
     2     General Fund, to be known as the CAP Fund.
     3         (2)  The following are the sources of money for the CAP
     4     Fund:
     5             (i)  Appropriations to the fund.
     6             (ii)  Money received from the Federal Government or
     7         other sources.
     8             (iii)  Money required to be deposited pursuant to
     9         other provisions of this part or any other law.
    10             (iv)  Money received under section 7203 (relating to
    11         fair share tax).
    12             (v)  Upon implementation of CAP:
    13                 (A)  Money appropriated for adultBasic under
    14             section 306(b)(1)(vi) of the Tobacco Settlement Act.
    15                 (B)  Money required to be dedicated to adultBasic
    16             or any alternative program to benefit persons of low-
    17             income under the Community Health Reinvestment
    18             Agreement within the respective service areas for
    19             each party to that agreement. Money under this clause
    20             shall only be used to defray the cost of the
    21             subsidies approved under subsection (e)(6).
    22             (vi)  Return on money in the fund.
    23         (3)  Money in the fund is hereby appropriated, upon
    24     approval of the Governor, to the fund to be used exclusively
    25     for the implementation and administration of CAP.
    26     (e)  Rates, premiums, discounts, and subsidies.--Rates,
    27  premiums, discounts and subsidies shall be determined in
    28  accordance with this subsection.
    29         (1)  Rates for CAP shall be approved annually by the
    30     department and may vary by region and contractor. Rates shall
    20070H0700B1011                 - 19 -     

     1     be based on actuarially sound and adequate review.
     2         (2)  Premiums for CAP:
     3             (i)  shall be established annually by the
     4         commissioner; and
     5             (ii)  may vary by region and contractor.
     6         (3)  Premiums to be paid by eligible small low-wage
     7     employer participants and enrollees under this subsection
     8     shall be increased by a factor no higher than the average of
     9     the change in the medical care component of the Consumer
    10     Price Index and the change in average wage for this
    11     Commonwealth as determined by the Department of Labor and
    12     Industry.
    13         (4)  Except as set forth in paragraph (7), the premium
    14     for eligible employee enrollees shall be discounted from the
    15     amount established under paragraph (2) in an amount
    16     determined annually by the commissioner. The premium discount
    17     shall not exceed 30%. The following apply:
    18             (i)  An eligible small low-wage employer participant:
    19                 (A)  shall pay at least 65% of the discounted
    20             premium for each employee enrolled; and
    21                 (B)  may pay more than 65% of the discounted
    22             premium for each employee.
    23             (ii)  An eligible employee enrollee not receiving a
    24         subsidy under paragraph (6) shall pay the balance of the
    25         discounted premium.
    26             (iii)  An eligible small low-wage employer
    27         participant shall sponsor a program that allows health
    28         insurance premiums paid by its employees to be made on a
    29         pretax basis and shall inform its employees of the
    30         availability of such program. The program shall include
    20070H0700B1011                 - 20 -     

     1         the following payments:
     2                 (A)  that portion of the discounted premium less
     3             applicable subsidies to be paid by its eligible
     4             employee enrollees;
     5                 (B)  CAP premiums paid for dependents of the
     6             employees; and
     7                 (C)  premiums paid by employees for CHIP.
     8         (5)  The premiums for eligible individual enrollees not
     9     receiving subsidies under paragraph (6) shall be at the full
    10     premium level.
    11         (6)  Subject to paragraph (7), an enrollee whose
    12     household income is at or below 300% of the Federal poverty
    13     level may apply to the department for a premium subsidy as
    14     follows:
    15             (i)  The department shall review and approve
    16         applications for subsidies under this paragraph.
    17             (ii)  Except to the extent that changes may be
    18         necessary to meet Federal requirements or to encourage
    19         eligible small low-wage employer participation or
    20         enrollment by eligible individuals, subsidies for the
    21         2007-2008 fiscal year are preliminarily estimated to
    22         result in the following premium amount based on household
    23         income:
    24                 (A)  For an enrollee whose household income is
    25             not greater than 100% of the Federal poverty level, a
    26             monthly premium of $10.
    27                 (B)  For an enrollee whose household income is
    28             greater than 100% but not greater than 200% of the
    29             Federal poverty level, a monthly premium of $40.
    30                 (C)  For an enrollee whose household income is
    20070H0700B1011                 - 21 -     

     1             greater than 200% but not greater than 300% of the
     2             Federal poverty level, a monthly premium of $60.
     3             (iii)  For fiscal years beginning after June 30,
     4         2008, the commissioner may establish different subsidy
     5         amounts and shall forward notice of the new premium
     6         amounts to the Legislative Reference Bureau for
     7         publication in the Pennsylvania Bulletin.
     8             (iv)  An enrollee who receives a subsidy under this
     9         paragraph must do all of the following:
    10                 (A)  Verify household income and household
    11             composition with the department every six months.
    12                 (B)  Notify the department in writing within 30
    13             days of a change in household income or composition.
    14         (7)  The following apply:
    15             (i)  An enrollee who is paid the prevailing wage
    16         while working on a public work as required by the
    17         Prevailing Wage Act, and who is otherwise entitled to a
    18         subsidy under paragraph (6), shall be subject to a
    19         reduction of the subsidy on a dollar-for-dollar basis for
    20         every dollar paid to the enrollee as part of the
    21         prevailing wage requirement which is allocable for use in
    22         the purchase of health care benefits.
    23             (ii)  A small low-wage employer participant that has
    24         a contract to perform work on a public work subject to
    25         the Prevailing Wage Act shall not be entitled to the
    26         premium discount provided under paragraph (4) during the
    27         term of the contract.
    28         (8)  The department shall freeze enrollment and establish
    29     waiting lists to assure that the Commonwealth's costs to
    30     implement and administer CAP do not exceed funds made
    20070H0700B1011                 - 22 -     

     1     available for CAP.
     2         (9)  Notwithstanding any other law to the contrary,
     3     employer-based coverage may, in the commissioner's sole
     4     discretion, be purchased in place of enrollment in CAP or may
     5     be purchased in conjunction with any portion of CAP provided
     6     outside the scope of CAP contracts by the Commonwealth paying
     7     the employee's share of the premium to the employer if it is
     8     more cost effective for the Commonwealth to purchase health
     9     care coverage from an enrollee's employer-based program than
    10     to pay the Commonwealth's share of a subsidized premium. This
    11     paragraph shall apply to any employer-based program, whether
    12     individual or family, such that if the Commonwealth's share
    13     of the enrollee plus its share for any spouse under CAP or
    14     children under CHIP is greater than the enrollee's premium
    15     share for family coverage under the employer-based program,
    16     the Commonwealth may choose to pay the latter alone or in
    17     combination with providing any benefit the Commonwealth does
    18     not provide through its CAP contracts.
    19     (f)  Duties of department.--The department has the following
    20  duties:
    21         (1)  Administer CAP on a Statewide basis.
    22         (2)  Solicit bids or proposals and award contracts for
    23     the basic benefit package through a competitive procurement
    24     in accordance with 62 Pa.C.S. (relating to procurement) and
    25     subsection (g). The department may award contracts on a
    26     multiple award basis as described in 62 Pa.C.S. § 517
    27     (relating to multiple awards).
    28         (3)  Impose reasonable cost-sharing arrangements and
    29     encourage appropriate use by contractors of cost-effective
    30     health care providers who will provide quality health care by
    20070H0700B1011                 - 23 -     

     1     establishing and adjusting copayments to be incorporated into
     2     CAP by contractors. The department shall forward changes to
     3     copayments to the Legislative Reference Bureau for
     4     publication in the Pennsylvania Bulletin. Changes shall be
     5     implemented by contractors as soon as practicable following
     6     publication, but in no event more than 120 days following
     7     publication.
     8         (4)  Ensure that the eligibility of eligible small low-
     9     wage employer participants and enrollees receiving subsidies
    10     are redetermined every six months.
    11         (5)  In consultation with other appropriate Commonwealth
    12     agencies, conduct monitoring and oversight of contracts
    13     entered into with contractors.
    14         (6)  In consultation with other appropriate Commonwealth
    15     agencies, monitor, review and evaluate the adequacy,
    16     accessibility and availability of services delivered to
    17     enrollees.
    18         (7)  In consultation with other appropriate Commonwealth
    19     agencies, establish and coordinate the development,
    20     implementation and supervision of an outreach plan to ensure
    21     that all those who may be eligible are aware of CAP. The plan
    22     shall include provisions for:
    23             (i)  reaching special populations, including nonwhite
    24         and non-English-speaking individuals and individuals with
    25         disabilities;
    26             (ii)  reaching different geographic areas, including
    27         rural and inner-city areas; and
    28             (iii)  assuring that special efforts are coordinated
    29         within the overall outreach activities throughout this
    30         Commonwealth.
    20070H0700B1011                 - 24 -     

     1         (8)  At the request of an individual enrollee, facilitate
     2     the payment on a pretax basis of premiums:
     3             (i)  for CAP and dependents covered under CAP; or
     4             (ii)  if applicable, for CHIP.
     5         (9)  To establish penalties for persons who enroll in
     6     CAP, drop enrollment and subsequently re-enroll for the
     7     purpose of avoiding the ongoing payment of premiums.
     8     (g)  Submitting proposals and awarding contracts.--
     9         (1)  Each professional health service plan corporation
    10     and hospital plan corporation and their subsidiaries and
    11     affiliates doing business in this Commonwealth shall submit a
    12     bid or proposal to the department to carry out the purposes
    13     of this section in the geographic area serviced by the
    14     corporation. All other insurers may submit a bid or proposal
    15     to the department to carry out the purposes of this section.
    16         (2)  The department shall review and score the bids or
    17     proposals on the basis of all of the requirements for CAP.
    18     The department may include other criteria in the solicitation
    19     and in the scoring and selection of the bids or proposals
    20     that the department, in the exercise of its duties under
    21     subsection (f), deems necessary. The department shall do all
    22     of the following:
    23             (i)  Select, to the greatest extent practicable,
    24         offerors that contract with health care providers to
    25         provide health care services on a cost-effective basis.
    26         The department shall select offerors that use appropriate
    27         cost-management methods, including the chronic care
    28         model, which will enable CAP to provide coverage to the
    29         maximum number of enrollees.
    30             (ii)  Select, to the greatest extent practicable,
    20070H0700B1011                 - 25 -     

     1         only offerors that comply with all procedures relating to
     2         coordination of benefits as required by the department
     3         and the Department of Public Welfare.
     4         (3)  Contracts may be for an initial term of up to five
     5     years, with options to extend for five one-year periods.
     6     (h)  Rates and charges.--
     7         (1)  The medical loss ratio for a contract shall be no
     8     less than 85%.
     9         (2)  No enrollee shall be charged a fee by any person as
    10     a requirement for enrolling in CAP.
    11     (i)  Participation by eligible small low-wage employers.--
    12         (1)  An eligible small low-wage employer seeking to
    13     participate in the CAP program must do all of the following:
    14             (i)  Select and contact a contractor that services
    15         its geographic area from a list of CAP contractors posted
    16         on the department's CAP website or otherwise obtained
    17         from the department upon request.
    18             (ii)  Adequately inform employees of the opportunity
    19         to enroll in CAP and the process for enrollment required
    20         by the contractor.
    21             (iii)  Comply with all other relevant provisions of
    22         this part.
    23         (2)  Eligible employee enrollees must do all of the
    24     following:
    25             (i)  Comply with the application and other enrollment
    26         requirements of the contractor.
    27             (ii)  Pay the required premium.
    28     (j)  Termination of employment.--An eligible employee
    29  enrollee who is terminated from employment shall be eligible to
    30  continue participating in CAP if the eligible employee enrollee
    20070H0700B1011                 - 26 -     

     1  continues to meet the requirements of an eligible individual
     2  enrollee and pays any increased premium required.
     3     (k)  Enrollment by eligible individuals.--An eligible
     4  individual seeking to purchase insurance through CAP must do all
     5  of the following:
     6         (1)  Select and contact a contractor that services the
     7     eligible individual's geographic area from a list of CAP
     8     contractors posted on the department's CAP website or
     9     otherwise obtained from the department upon request.
    10         (2)  Comply with the application and other enrollment
    11     requirements of the contractor.
    12         (3)  Pay the required premium directly to the contractor.
    13         (4)  Comply with all other relevant provisions of this
    14     part.
    15     (l)  Basic benefit package.--
    16         (1)  The basic benefit package to be offered under CAP
    17     shall be of the scope and duration as the department
    18     determines and shall provide for all of the following which
    19     may be limited or unlimited as the department may determine:
    20     preliminary and annual health assessments; emergency care;
    21     inpatient and outpatient care; prescription drugs, medical
    22     supplies and equipment; emergency dental care; maternity
    23     care; skilled nursing; home health and hospice care; chronic
    24     disease management; preventive and wellness care; and
    25     inpatient and outpatient behavioral health services.
    26         (2)  The Commonwealth may elect to provide any benefit
    27     independently and outside the scope of CAP contracts.
    28         (3)  Enrollment in CAP shall not be prohibited based upon
    29     a preexisting condition, nor shall a CAP benefit plan exclude
    30     a diagnosis or treatment for a condition based upon its
    20070H0700B1011                 - 27 -     

     1     preexistence.
     2     (m)  Data matching.--
     3         (1)  All entities providing health insurance or health
     4     care coverage within this Commonwealth shall, not less
     5     frequently than once every month, provide the names,
     6     identifying information and such additional information on
     7     coverage and benefits as the department may specify for all
     8     individuals for whom the entities provide insurance or
     9     coverage.
    10         (2)  The department shall use the information obtained in
    11     paragraph (1) to determine whether any portion of an
    12     enrollee's premium is being paid from any other source and to
    13     determine whether another entity has primary liability for
    14     any health care claims paid under any program administered by
    15     the department. If a determination is made that an enrollee's
    16     premium is being paid from another source, the department
    17     shall not make any additional payments to the insurer for
    18     such enrollee.
    19         (3)  If any payment has been made to an insurer by the
    20     department for an enrollee for whom any portion of the
    21     premium paid by the department is being paid from another
    22     source, the insurer shall reimburse the department the amount
    23     of any such excess payment or payments.
    24         (4)  The department may seek reimbursement from an entity
    25     that provides health insurance or health care coverage that
    26     is primary to the coverage provided under any program
    27     administered by the department.
    28         (5)  To the maximum extent permitted by law, and
    29     notwithstanding any policy or plan provision to the contrary,
    30     a claim by the department for reimbursement under paragraph
    20070H0700B1011                 - 28 -     

     1     (3) or (4) shall be deemed timely filed if it is filed with
     2     the insurer or entity within three years following the date
     3     of payment.
     4         (6)  The department is authorized to enter into
     5     agreements with entities providing health insurance and
     6     health care coverage for the purpose of carrying out the
     7     provisions of this subsection. The agreements shall provide
     8     for the electronic exchange of data between the parties at a
     9     mutually agreed upon frequency, but no less than once every
    10     two months, and may also allow for payment of a fee by the
    11     department to the entity providing health insurance or health
    12     care coverage.
    13         (7)  The department shall determine that no other health
    14     care coverage is available to the enrollee through an alimony
    15     agreement or an employment-related or other group basis. If
    16     such health care coverage is available, the department shall
    17     re-evaluate the enrollee's eligibility under this section.
    18         (8)  The commissioner may impose a penalty of up to
    19     $1,000 per violation upon any entity that fails to comply
    20     with the obligations imposed by this section. All funds
    21     collected under this paragraph shall be deposited into the
    22     CAP Fund.
    23         (9)  The department shall coordinate with the Department
    24     of Public Welfare in the implementation of this section and
    25     may designate the Department of Public Welfare to perform
    26     such duties as are appropriate under this section.
    27     (n)  Information to be provided by insurers.--
    28         (1)  Each hospital plan corporation and professional
    29     health services corporation shall provide an individual in
    30     this Commonwealth who has applied for insurance through its
    20070H0700B1011                 - 29 -     

     1     Special Care product with written information in plain
     2     language about the existence of CAP, the benefits it covers
     3     and the cost to the individual to purchase so that the
     4     individual applying for insurance through Special Care can
     5     compare the costs and benefits of it and CAP.
     6         (2)  Each hospital plan corporation and a professional
     7     health services corporation shall develop written materials
     8     which comply with paragraph (1) and submit them to the
     9     department for review and approval.
    10         (3)  Only materials approved by the department under
    11     paragraph (2) may be provided to applicants for a Special
    12     Care product offered in this Commonwealth.
    13     (o)  Regulations.--The department may promulgate regulations
    14  for the implementation and administration of this section.
    15     (p)  Federal waivers.--The Department of Public Welfare, in
    16  cooperation with the department, shall apply for all applicable
    17  waivers from the Federal Government and shall seek approval to
    18  amend the State plan as necessary to carry out the provisions of
    19  this part. If the Department of Public Welfare receives approval
    20  of a waiver or approval of a State plan amendment as required by
    21  this subsection, it shall notify the department and shall
    22  transmit notice of the waiver or State plan amendment approvals
    23  to the Legislative Reference Bureau for publication as a notice
    24  in the Pennsylvania Bulletin. The department is authorized to
    25  change the benefits and the premium and copayment amounts
    26  payable under subsection (e) in order for CAP to meet Federal
    27  requirements.
    28     (q)  Federal funds.--Notwithstanding any other provision of
    29  law, the Department of Public Welfare, in cooperation with the
    30  department, shall take any action necessary to do all of the
    20070H0700B1011                 - 30 -     

     1  following:
     2         (1)  Ensure the receipt of Federal financial
     3     participation under Title XIX of the Social Security Act (49
     4     Stat. 620, 42 U.S.C. § 1396 et seq.) for coverage and for
     5     services provided under this part.
     6         (2)  Qualify for available Federal financial
     7     participation under Title XIX of the Social Security Act.
     8     (r)  Entitlements and claims.--Nothing in this section shall
     9  constitute an entitlement derived from the Commonwealth or a
    10  claim on any funds of the Commonwealth.
    11     (s)  Option to limit or not to proceed.--Notwithstanding any
    12  other provision of this section, in the event that Federal
    13  waiver requirements limit CAP such that only a portion of those
    14  individuals otherwise eligible may be covered, the Commonwealth
    15  may limit CAP to that portion or, at its option, determine not
    16  to proceed with the CAP program.
    17  § 7203.  Fair share tax.
    18     (a)  Imposition of tax.--In order to help fund the
    19  Commonwealth's cost of implementing and administering CAP, each
    20  employer shall be subject to a fair share tax as follows:
    21         (1)  For fiscal years 2007-2008 through 2009-2010, 3% of
    22     the wages paid by the employer.
    23         (2)  For fiscal years commencing after June 30, 2010,
    24     3.5% of the wages paid by the employer.
    25     (b)  Credits against tax.--
    26         (1)  For fiscal years 2007-2008 through 2011-2012, the
    27     amount of the tax to which an employer is otherwise subject
    28     may be reduced by the amount of a quarterly start-up credit
    29     as follows:
    30             (i)  Fiscal year 2007-2008                 $15,000.00
    20070H0700B1011                 - 31 -     

     1             (ii)  Fiscal year 2008-2009                $12,000.00
     2             (iii)  Fiscal year 2009-2010               $ 9,750.00
     3             (iv)  Fiscal year 2010-2011                $ 7,700.00
     4             (v)  Fiscal year 2011-2012                 $ 3,981.25
     5             (vi)  Fiscal year 2012-2013 and thereafter $     0.00
     6         (2)  The following apply:
     7             (i)  An employer that offers qualifying health care
     8         coverage to each of its employees who works 30 hours per
     9         week or more following no more than 90 days of continued
    10         employment shall be entitled to a credit against the fair
    11         share tax in an amount equal to 3% of the employer's
    12         wages for fiscal years 2007-2008 through 2009-2010 and
    13         3.5% of the employer's wages for fiscal years commencing
    14         after June 30, 2010.
    15             (ii)  The Department of Labor and Industry, in
    16         consultation with the department, shall determine whether
    17         the employer's offer shall be considered as qualifying
    18         health care coverage based on the premium and out-of-
    19         pocket costs to the employee and the level of employee
    20         participation. In the case of multiple plans offered by
    21         the same employer, the determination shall be based on
    22         the cost to the lowest wage employees of the employer and
    23         the relative participation of those employees.
    24         (3)  The total amount of the credits under this
    25     subsection shall not exceed the amount of fair share tax
    26     imposed under subsection (a) for the year the credit is
    27     granted.
    28         (4)  The credits under this subsection may not be carried
    29     back or carried forward to other years, refunded, assigned or
    30     sold.
    20070H0700B1011                 - 32 -     

     1     (c)  Reports by employers.--
     2         (1)  If an employer's liability for fair share tax for a
     3     calendar quarter, determined without regard to subsection
     4     (b)(2), exceeds the amount of credit available to the
     5     employer pursuant to subsection (b)(1) for that calendar
     6     quarter, the employer shall file a report with the Department
     7     of Labor and Industry for that calendar quarter. The report
     8     shall be due by the last day of the month immediately
     9     following the calendar quarter. The report shall be made in a
    10     manner prescribed by the Department of Labor and Industry and
    11     shall contain all information required by the Department of
    12     Labor and Industry, including the following:
    13             (i)  The amount of wages paid by the employer during
    14         the calendar quarter.
    15             (ii)  A certification that the employer did or did
    16         not satisfy the requirements for the credit under
    17         subsection (b)(2) throughout the calendar quarter.
    18         (2)  Each employer shall file any other reports required
    19     by the Department of Labor and Industry in the administration
    20     of this section, which reports shall be made in the manner
    21     prescribed by the Department of Labor and Industry and
    22     contain all information required by the Department of Labor
    23     and Industry.
    24     (d)  Payment of tax.--Concurrently with each report required
    25  under subsection (c), the employer shall pay to the Department
    26  of Labor and Industry the amount of fair share tax imposed under
    27  this section for the period covered by the report.
    28     (e)  Penalties.--
    29         (1)  An employer that does not make and file the periodic
    30     reports required by subsection (c) in the manner prescribed
    20070H0700B1011                 - 33 -     

     1     by the Department of Labor and Industry on or before the date
     2     such report is required to be filed shall pay a penalty.
     3         (2)  The amount of the penalty shall be 10% of the amount
     4     of fair share tax due for the period and shall be not less
     5     than $50 or more than $5,000.
     6         (3)  All penalties collected under this subsection shall
     7     be deposited into the CAP Fund.
     8     (f)  Interest.--
     9         (1)  Fair share taxes or penalties unpaid on the date on
    10     which they are due and payable shall bear interest at the
    11     greater of:
    12             (i)  one-twelfth of the annual rate determined by the
    13         Secretary of Revenue under section 806 of the act of
    14         April 9, 1929 (P.L.343, No.176), known as The Fiscal
    15         Code, per month or fraction of a month; or
    16             (ii)  the rate of 0.75% per month or fraction of a
    17         month from the date they become due until paid.
    18         (2)  All interest collected under this subsection shall
    19     be deposited into the CAP Fund.
    20     (g)  Refunds.--
    21         (1)  If an employer applies for refund or credit of any
    22     amount paid as fair share tax, interest or penalties and the
    23     Department of Labor and Industry determines that such amount,
    24     or any portion thereof, was erroneously collected, the
    25     Department of Labor and Industry may at its discretion either
    26     allow a credit, without interest, against subsequent fair
    27     share tax payments or shall refund from the CAP Fund, without
    28     interest, the amount erroneously paid.
    29         (2)  No refund or credit shall be allowed with respect to
    30     a payment as fair share tax, interest or penalties, unless
    20070H0700B1011                 - 34 -     

     1     the employer files an application on or before the later of:
     2             (i)  one year from the date on which such payment was
     3         made; or
     4             (ii)  four years from the reporting due date of the
     5         reporting period with respect to which such payment was
     6         made.
     7         (3)  For a like cause and within the same period, a
     8     refund may be made or a credit allowed on the initiative of
     9     the Department of Labor and Industry.
    10     (h)  Collections and enforcement.--
    11         (1)  Records maintained by employers pursuant to section
    12     206(a) of the Unemployment Compensation Law and corresponding
    13     regulations shall be open to inspection by the Department of
    14     Labor and Industry for purposes of this section to the same
    15     extent that they are open to inspection for purposes of the
    16     Unemployment Compensation Law.
    17         (2)  The provisions of sections 304(a) through (d),
    18     305(c), 308.1, 309 and 309.2 of the Unemployment Compensation
    19     Law are incorporated into this section and shall be
    20     applicable to the fair share tax, interest and penalties.
    21     References in such provisions of the Unemployment
    22     Compensation Law to contributions shall be deemed to be
    23     references to the fair share tax for purposes of this
    24     section.
    25     (i)  False statements and representations and other
    26  offenses.--
    27         (1)  An employer, whether or not liable for the payment
    28     of fair share taxes under this subsection, or an officer or
    29     agent of an employer or any other person who does any of the
    30     following commits a summary offense and shall, upon
    20070H0700B1011                 - 35 -     

     1     conviction, be sentenced to pay a fine of not less than $100
     2     nor more than $1,500 or to imprisonment for not longer than
     3     30 days, or both:
     4             (i)  makes a false statement or representation
     5         knowing it to be false, or knowingly fails to disclose a
     6         material fact to avoid becoming or remaining subject
     7         hereto or to avoid or reduce any fair share tax or other
     8         payment required from an employer under this section;
     9             (ii)  willfully fails or refuses to make fair share
    10         tax or other payment required under this section;
    11             (iii)  willfully fails or refuses to produce or
    12         permit the inspection or copying of records as required
    13         under this section; or
    14             (iv)  willfully fails or refuses to furnish any
    15         report required by subsection (c) or the rules or
    16         regulations of the Department of Labor and Industry.
    17         (2)  The number of offenses under paragraph (1) shall be
    18     determined as follows:
    19             (i)  Each false statement or representation or
    20         failure to disclose a material fact shall constitute a
    21         separate offense under paragraph (1)(i).
    22             (ii)  Each day of failure or refusal shall constitute
    23         a separate offense under paragraph (1)(ii), (iii) and
    24         (iv).
    25             (iii)  Each report required by subsection (c) or the
    26         rules or regulations of the Department of Labor and
    27         Industry shall be the basis of a separate offense under
    28         paragraph (1)(iv).
    29         (3)  In addition to any other sanction, an employer,
    30     officer, agent or other person convicted under this section
    20070H0700B1011                 - 36 -     

     1     for willful failure or refusal to make a payment shall be
     2     ordered to make restitution of the unpaid amounts, including
     3     interest and penalty from the date the payment was due
     4     through the date of payment.
     5         (4)  For purposes of this subsection, the term
     6     "willfully" shall have the meaning given to it under 18
     7     Pa.C.S. § 302 (relating to general requirements of
     8     culpability).
     9     (j)  Powers and duties of Department of Labor and Industry.--
    10         (1)  The Department of Labor and Industry shall
    11     administer and enforce this section and adopt, amend and
    12     rescind such rules, regulations and guidance, require such
    13     reports from employers, employees and any other person deemed
    14     by the Department of Labor and Industry to be affected by
    15     this section, make such investigations and take such other
    16     action as it deems necessary or suitable. Such rules,
    17     regulations and guidance shall not be inconsistent with the
    18     provisions of this section.
    19         (2)  In the discharge of the duties imposed by this
    20     section, the Secretary of Labor and Industry and any agent
    21     duly authorized in writing by him shall have the power to
    22     administer oaths and affirmations, take depositions and
    23     certify to official acts.
    24         (3)  The Department of Labor and Industry may issue
    25     subpoenas to compel the attendance of witnesses and the
    26     production of books, papers, correspondence, memoranda and
    27     other records deemed necessary in the administration of this
    28     section.
    29  § 7204.  Health insurance rate increases and standard plans.
    30     (a)  Applicability.--This section applies to all insurers
    20070H0700B1011                 - 37 -     

     1  that offer small group health benefit plans and individual
     2  health benefit plans that are issued, made effective, delivered
     3  or renewed in this Commonwealth after the effective date of this
     4  section.
     5     (b)  Premium rates.--
     6         (1)  An insurer shall establish a community rate for
     7     plans subject to this section and shall file the community
     8     rate with the department as required by law. An insurer may
     9     adjust its community rate for the following:
    10             (i)  age;
    11             (ii)  geographic region as approved by the
    12         department; and
    13             (iii)  family composition.
    14         (2)  An insurer shall apply all risk adjustment factors
    15     under paragraph (1) consistently with respect to all plans
    16     subject to this section.
    17         (3)  An insurer shall not charge a rate that is more than
    18     33% above or below the community rate, as adjusted as
    19     permitted under paragraph (1).
    20         (4)  An insurer shall base its rating methods and
    21     practices on commonly accepted actuarial assumptions and
    22     sound actuarial principles. Rates shall not be excessive,
    23     inadequate or unfairly discriminatory.
    24         (5)  For purposes of this subsection, an insurer's
    25     "community rate" for a plan shall refer to a rating
    26     methodology that is based on the experience of all risks
    27     covered by the plan without regard to health status,
    28     occupation or any other factor.
    29     (c)  Additional rate review.--
    30         (1)  In conjunction with and in addition to the standards
    20070H0700B1011                 - 38 -     

     1     set forth in the Accident and Health Filing Reform Act and
     2     all other applicable statutory and regulatory requirements,
     3     the department may disapprove a rate filing based on any of
     4     the following:
     5             (i)  The rate is not actuarially sound.
     6             (ii)  The increase is requested because the insurer
     7         has not operated efficiently or has factored in
     8         experience that conflicts with recognized best practices
     9         in the health care industry.
    10             (iii)  The increase is requested because the insurer
    11         has incurred costs of additional care due to avoidable
    12         hospital-acquired infections and avoidable
    13         hospitalizations due to ineffective chronic care
    14         management, after data for the incidents has become
    15         available to and can be analyzed by the insurer and the
    16         department.
    17             (iv)  For small group health plans, the medical loss
    18         ratio is less than 85%.
    19         (2)  In the event a small group health benefit plan has a
    20     medical loss ratio of less than 85%, the department may, in
    21     addition to any other remedies available under law, require
    22     the insurer to refund the difference to policyholders on a
    23     pro rata basis as soon as practicable following receipt of
    24     notice from the department of the requirement but in no event
    25     later than 120 days following receipt of the notice. The
    26     department shall establish procedures for the circumstances
    27     under which such refunds will be required.
    28         (3)  The filing and review procedures set forth in the
    29     Accident and Health Filing Reform Act shall apply to any
    30     filing conducted pursuant to this section.
    20070H0700B1011                 - 39 -     

     1     (d)  Standard plans required.--
     2         (1)  An insurer shall not offer a plan that does not meet
     3     the minimum benefits specified in one of the standard plans
     4     developed by the department in accordance with the following
     5     criteria:
     6             (i)  The standard plans shall at least include all of
     7         the benefits of the basic benefit package, except that
     8         they shall not include coverage for behavioral health
     9         services.
    10             (ii)  The standard plans may not contain any
    11         preexisting condition exclusions.
    12         (2)  Standard plans may include options for deductible
    13     and cost-sharing provisions if the department determines that
    14     the provisions:
    15             (i)  Dissuade consumers from seeking unnecessary
    16         services.
    17             (ii)  Balance the effect of cost sharing in reducing
    18         premiums and in effecting utilization of appropriate
    19         services.
    20             (iii)  Limit the total cost sharing that may be
    21         incurred by an individual in a year.
    22         (3)  Each individual in this Commonwealth who applies to
    23     an insurer for enrollment in one of the standard plans
    24     offered by an insurer shall be enrolled.
    25         (4)  The following apply:
    26             (i)  The department shall forward the elements of the
    27         standard plans to the Legislative Reference Bureau for
    28         publication as a notice in the Pennsylvania Bulletin.
    29             (ii)  An insurer subject to the provisions of this
    30         section shall be required to begin offering its standard
    20070H0700B1011                 - 40 -     

     1         plans as soon as practicable following the publication
     2         but in no event later than 120 days following the
     3         publication.
     4     (e)  Additional benefits.--
     5         (1)  An insurer shall offer as an additional benefit to
     6     every standard plan a behavioral health services benefit that
     7     complies with the provisions of sections 601-A, 602-A, 603-A,
     8     604-A, 605-A, 606-A, 607-A and 608-A of the act of May 17,
     9     1921 (P.L.682, No.284), known as The Insurance Company Law of
    10     1921.
    11         (2)  An insurer may offer benefits in addition to those
    12     in any of its standard plans.
    13         (3)  Each additional benefit shall:
    14             (i)  Be offered and priced separately from benefits
    15         specified in the standard plan with which the benefits
    16         are being offered.
    17             (ii)  Not have the effect of duplicating any of the
    18         benefits in the standard plan with which the benefits are
    19         being offered.
    20             (iii)  Be clearly specified as additions to the
    21         standard plan with which the benefits are being offered.
    22         (4)  The department may prohibit an insurer from offering
    23     an additional benefit under this section if the department
    24     finds that the additional benefit will be sold in conjunction
    25     with one of the insurer's standard plans in a manner designed
    26     to promote risk selection or underwriting practices otherwise
    27     prohibited by this section or other State law.
    28     (f)  Regulations.--The department may promulgate regulations
    29  necessary for the implementation and administration of this
    30  section.
    20070H0700B1011                 - 41 -     

     1  § 7205.  Health insurance coverage for full-time students.
     2     (a)  Minimum health benefit package.--Within 90 days
     3  following the effective date of this section, the commissioner
     4  shall establish a minimum health benefit package for full-time
     5  students enrolled in public or private baccalaureate and post
     6  baccalaureate programs in Pennsylvania and transmit a
     7  description of the package to the Legislative Reference Bureau
     8  for publication in the Pennsylvania Bulletin. As soon as
     9  practicable after the date of publication of the package, but in
    10  no event later than 120 days following such publication, all
    11  insurers shall offer the package as individual coverage
    12  available to students and as group coverage through the
    13  institution. The commissioner may make revisions to the minimum
    14  health benefit package periodically, but no more than one time
    15  per 12-month period. Each revision shall be implemented by
    16  insurers as soon as practicable following publication of the
    17  revision in the Pennsylvania Bulletin but in no event later than
    18  120 days following such publication.
    19     (b)  Mandatory coverage.--
    20         (1)  Every full-time student enrolled in a public or
    21     private baccalaureate or post baccalaureate program in
    22     Pennsylvania shall maintain health insurance coverage which
    23     provides the minimum benefit package established in this
    24     section. The coverage shall be maintained throughout the
    25     period of the student's enrollment.
    26         (2)  Every student required to have mandatory coverage
    27     under this section shall present evidence of such coverage to
    28     the institution in which the student is enrolled at least
    29     annually, in a manner prescribed by the institution.
    30         (3)  Every public or private college or university or
    20070H0700B1011                 - 42 -     

     1     post baccalaureate program in Pennsylvania shall make
     2     available health insurance coverage, including CAP for those
     3     who are eligible under section 7202 (relating to Cover All
     4     Pennsylvanians health insurance program), on a group or
     5     individual basis for purchase by students who are required to
     6     maintain the coverage pursuant to this section.
     7         (4)  Notwithstanding the provisions of paragraphs (1),
     8     (2) and (3), the requirements of this section may be
     9     satisfied if the baccalaureate or post baccalaureate program
    10     provides on-campus student health care coverage equivalent to
    11     the minimum benefit package through its own clinics and
    12     health care facilities and receives approval from the
    13     department that such equivalent coverage meets the minimum
    14     benefit package. Such coverage shall provide that the student
    15     is covered for hospital admissions and emergency services at
    16     facilities throughout this Commonwealth.
    17     (c)  Annual certification.--Every public or private
    18  baccalaureate or post baccalaureate program in this Commonwealth
    19  shall certify to the department at least annually that the
    20  requirements of this section have been met for all periods of
    21  the preceding year.
    22     (d)  Penalty for failure to comply.--The commissioner may
    23  impose a fine of up to $500 per day for each day that a public
    24  or private baccalaureate or post baccalaureate program fails to
    25  meet any of its obligations in this section. The fine shall be
    26  due within 30 days following receipt by the institution of
    27  notice of the violation. Funds collected under this subsection
    28  shall be deposited into the CAP Fund.
    29  § 7206.  Health insurance coverage for certain children of
    30             insured parents.
    20070H0700B1011                 - 43 -     

     1     (a)  Option to cover certain children.--An insurer that
     2  issues, delivers, executes or renews health care insurance in
     3  this Commonwealth, under which coverage of a child would
     4  otherwise terminate at a specified age, shall, at the option of
     5  the child's parent or guardian, provide coverage to a child of
     6  the insured beyond that specified age, up through the age of 29,
     7  provided that the child meets all of the following requirements:
     8         (1)  Is not married.
     9         (2)  Has no dependents.
    10         (3)  Is a resident of this Commonwealth or is enrolled as
    11     a full-time student at an institution of higher education in
    12     this Commonwealth.
    13         (4)  Is not covered by another health insurance policy.
    14     (b)  Exercise of option.--An insured may exercise the option
    15  provided by subsection (a) at any time during the term of the
    16  policy by notice to the insurer.
    17     (c)  Employer contribution.--Employers shall not be required
    18  to contribute to any increased premium charged by the insurer
    19  for the exercise of the option provided by subsection (a), but
    20  such contributions may be agreed to by the employer.
    21  § 7207.  Hospital community benefit requirements.
    22     (a)  Community needs assessment.--
    23         (1)  By January 1, 2008, each hospital operating as a
    24     charitable institution shall complete a community needs
    25     assessment in accordance with guidelines established by the
    26     Department of Health in order to identify, for its primary
    27     service area as determined by the hospital, unmet needs to
    28     improve or maintain health status in the community,
    29     particularly with respect to those vulnerable populations
    30     exposed to medical or financial risk by virtue of being
    20070H0700B1011                 - 44 -     

     1     uninsured, underinsured or eligible for public health
     2     programs. The hospital may conduct the assessment:
     3             (i)  alone;
     4             (ii)  in conjunction with other health care
     5         providers; or
     6             (iii)  through other organizational arrangements.
     7         (2)  The hospital shall conduct its community needs
     8     assessment by including a process for consulting with
     9     community groups and local government officials in
    10     identifying and prioritizing community needs that the
    11     hospital can address directly, in collaboration with others
    12     or through other organizational arrangements. The community
    13     needs assessment shall be updated at least once every three
    14     years.
    15     (b)  Community benefits report.--
    16         (1)  On or before April 1, 2008, and every calendar year
    17     thereafter, each hospital subject to the provisions of
    18     subsection (a) shall prepare a community benefits report
    19     containing the following information with respect to the
    20     immediately preceding calendar year:
    21             (i)  The specific criterion under section 5(d)(1) of
    22         the Institutions of Purely Public Charity Act that the
    23         hospital asserts qualifies it as providing benefits to
    24         the community and the calculation of the dollar amount
    25         that the criterion requires the hospital to meet.
    26             (ii)  A description and dollar value of the
    27         uncompensated goods or services that the hospital has
    28         provided to address the specific community needs
    29         identified in the community needs assessment.
    30         (2)  The amount attributed to uncompensated goods or
    20070H0700B1011                 - 45 -     

     1     services as set forth in the Institutions of Purely Public
     2     Charity Act for the purposes of this report shall be further
     3     limited as follows:
     4             (i)  The full cost of uncompensated health care
     5         services shall be calculated as the Medicare
     6         reimbursement the hospital would otherwise receive for
     7         those services.
     8             (ii)  The reasonable value of volunteer assistance
     9         donated by individuals who are employed or otherwise
    10         affiliated with the provision of health care services by
    11         the hospital shall only include community services or
    12         programs related to the mission of the hospital, but
    13         which are not provided in or by the hospital.
    14             (iii)  The term uncompensated goods or services shall
    15         not include the following:
    16                 (A)  Bad debt.
    17                 (B)  Health screening, health education classes
    18             or other programs either designed to increase market
    19             share or for which a fee is charged or a referral to
    20             the hospital is made.
    21                 (C)  Programs provided as an employee benefit.
    22                 (D)  Use of facility space to hold meetings for
    23             community groups.
    24                 (E)  Expenses for in-service training, continuing
    25             education, orientation, mentoring or joint
    26             appointments.
    27     (c)  Filing and publication.--Each hospital subject to the
    28  provisions of subsection (a) shall file its report on or before
    29  April 15 of each calendar year with the Department of Health and
    30  shall publish its community needs assessment and annual report
    20070H0700B1011                 - 46 -     

     1  on its hospital website and make them available to any member of
     2  the community upon request.
     3     (d)  Audit.--The Department of Health shall have authority to
     4  audit a hospital's community benefit report at any time and
     5  disallow any amount claimed for uncompensated goods and services
     6  that does not comply with this section. A hospital shall retain
     7  records documenting the calculations contained in its community
     8  benefit report for a period of three years following issuance of
     9  the report.
    10     (e)  Fines.--
    11         (1)  A hospital that reports an amount of uncompensated
    12     goods and services under subsection (b)(1)(ii) that is lower
    13     than the amount it is required to provide under subsection
    14     (b)(1)(i) shall pay the difference to the Department of
    15     Health within 60 days following receipt of written notice
    16     from the Department of Health that the same is due.
    17         (2)  A false or misleading statement contained in a
    18     hospital's community benefit report or a failure to comply
    19     with the provisions of this section shall subject the
    20     hospital to a fine of $1,000 per day to be imposed and
    21     collected by the Department of Health.
    22         (3)  The fines imposed by paragraphs (1) and (2) shall be
    23     in addition to any other fine or penalty that may be imposed
    24     upon a hospital under the Institutions of Purely Public
    25     Charity Act.
    26         (4)  All fines collected under this subsection, as well
    27     as any fines or penalties collected from hospitals under the
    28     Institutions of Purely Public Charity Act, shall be deposited
    29     into the CAP Fund.
    30     (f)  Uncompensated care program.--Notwithstanding the
    20070H0700B1011                 - 47 -     

     1  provisions of Chapter 11 of the Tobacco Settlement Act to the
     2  contrary, a hospital subject to the provisions of this section
     3  shall only be entitled to apply for payment from the Hospital
     4  Uncompensated Care Program established under Chapter 11 equal to
     5  the amount by which the amount of uncompensated goods and
     6  services reported under the provisions of subsection (b)(1)(ii)
     7  exceeds the amount it is required to provide under subsection
     8  (b)(1)(i).
     9  § 7208.  Uniform admission and fair billing and collection
    10             practices.
    11     (a)  Admission criteria.--A hospital shall be subject to the
    12  following with respect to its admission criteria:
    13         (1)  A hospital may not deny admission, and a health care
    14     provider may not refuse to provide services, for reasons not
    15     based on sound medical practice to individuals seeking
    16     medical services requiring admission to the hospital.
    17     Admission policies and protocols shall be in plain language
    18     and available upon request. Admissions shall be prioritized
    19     on the basis of urgency of the medical condition and the
    20     immediate and long-term risk to the individual of going
    21     without medical care.
    22         (2)  No individual shall be denied necessary medical
    23     services from a hospital based on race, color, religion,
    24     gender, disability, sexual orientation, national origin or
    25     source of payment.
    26         (3)  A hospital shall facilitate the completion of an
    27     application for enrollment in medical assistance or CAP and,
    28     if applicable, CHIP, by any uninsured individual who presents
    29     at the hospital for admission or emergency services. The
    30     hospital shall deliver the completed application or
    20070H0700B1011                 - 48 -     

     1     applications by facsimile or other expeditious means to the
     2     appropriate county assistance office or, for CAP or CHIP, a
     3     contractor providing coverage for the individual's county of
     4     residence.
     5         (4)  When a hospital cannot provide the specific medical
     6     services required by a patient, the hospital shall make
     7     appropriate arrangements for transferring the patient to
     8     another hospital or other source of health care that can
     9     provide the required medical services.
    10         (5)  A hospital is not required to provide services or
    11     make a referral that is contrary to its stated ethical policy
    12     in accordance with the act of December 9, 2002 (P.L.1701,
    13     No.214), known as the Religious Freedom Protection Act,
    14     provided, however, that such hospital shall provide express
    15     notice to its patients of its policies regarding those health
    16     care services.
    17     (b)  Billing policies.--A hospital shall be subject to the
    18  following with respect to its billing policies:
    19         (1)  A hospital shall provide to the patient or the
    20     patient representative upon request an itemized bill and an
    21     explanation of all charges in plain language.
    22         (2)  Prior to admission or as soon as practicable
    23     thereafter, the hospital shall inform the patient or the
    24     patient representative if the hospital, its staff,
    25     contractors or subcontractors will not accept the patient's
    26     third-party payment.
    27         (3)  A hospital shall provide the patient, or the patient
    28     representative, with information and counseling on the
    29     availability of known financial resources for his health care
    30     and assist the patient or patient representative in enrolling
    20070H0700B1011                 - 49 -     

     1     in public programs, including CAP and CHIP, for which the
     2     patient may be eligible and in securing such other financial
     3     resources as may be available.
     4         (4)  A deposit shall not be required by a hospital where
     5     there is a reasonable expectation that the individual will
     6     qualify for CAP, CHIP, Medicare, medical assistance, other
     7     government programs or a private insurance program that will
     8     cover the services to be provided at the hospital.
     9         (5)  A hospital shall establish a process for receiving
    10     and reviewing billing complaints that includes a requirement
    11     that hospital staff address them in a specified, timely
    12     manner and shall notify the patient or patient representative
    13     of the complaint process upon admission to and at discharge
    14     from the hospital.
    15         (6)  In no event shall uninsured patients or self-pay
    16     patients be compelled to pay more than the Medicare
    17     reimbursement rate for the services provided.
    18         (7)  A hospital shall not, directly or indirectly, cause,
    19     facilitate, enable or otherwise require any patient or
    20     patient representative to enter into any third-party credit
    21     arrangement for the purpose of paying or securing payment for
    22     medical care.
    23     (c)  Collection policies.--A hospital shall be subject to the
    24  following with respect to its collection policies:
    25         (1)  It shall work with each patient to establish a
    26     reasonable payment plan consistent with this section and
    27     applicable Federal and State laws and regulations.
    28         (2)  It shall take legal action only when there is
    29     evidence that the patient or responsible party has income or
    30     assets or both to meet the financial obligation.
    20070H0700B1011                 - 50 -     

     1         (3)  It shall not force the sale or foreclosure of a
     2     patient's primary residence to pay an outstanding medical
     3     bill.
     4         (4)  It shall require that any collection agency engaged
     5     by the hospital follow the requirements of this subsection
     6     and any other obligations under Federal and State laws and
     7     regulations.
     8  § 7209.  Transparency in price and quality for consumers.
     9     (a)  The Pennsylvania Drug Retail Price Registry.--
    10         (1)  The council shall establish and maintain a registry
    11     to be known as the Pennsylvania Drug Retail Price Registry
    12     for the purpose of making retail price information for the
    13     150-most-frequently prescribed prescription drugs, together
    14     with their generic equivalents where applicable, readily
    15     available to consumers in this Commonwealth.
    16             (i)  The drug price registry shall include the
    17         information submitted to the council under this
    18         subsection and the name and address of each pharmacy
    19         providing the information and shall be organized by zip
    20         code.
    21             (ii)  The drug price registry shall be updated
    22         monthly by the council and shall be posted on the
    23         council's Internet website in a format that is conducive
    24         to review and comparison by consumers of prescription
    25         drug retail prices charged by pharmacies in each zip code
    26         within this Commonwealth. It shall include a toll-free
    27         telephone number maintained by the council that consumers
    28         may call to obtain reprints of the registry.
    29             (iii)  The website shall be designed so that the
    30         consumer may download and print the displayed information
    20070H0700B1011                 - 51 -     

     1         and shall include at least the following:
     2                 (A)  Internet web links to other government
     3             resources that provide information relating to the
     4             regulation of prescription drugs and Federal and
     5             State health care coverage and pharmaceutical
     6             assistance programs.
     7                 (B)  An advisory statement alerting consumers of
     8             the need to tell their health care practitioner and
     9             pharmacist about all the medications they may be
    10             taking and to ask them how to avoid harmful
    11             interactions between those drugs, if any.
    12                 (C)  Clearly understandable language that is
    13             designed to assist consumers in understanding the
    14             content of and how to access the information made
    15             available on the website pursuant to this subsection.
    16         (2)  Within 30 days following the effective date of this
    17     section, the director of PACE shall determine and submit to
    18     the Pennsylvania Bulletin for publication a list of the 150-
    19     most-frequently prescribed prescription drugs in this
    20     Commonwealth and their generic equivalents and the unit
    21     amount to be used for price reporting purposes. The list
    22     shall be updated by the director of PACE annually thereafter,
    23     and each such update shall be submitted to the Legislative
    24     Reference Bureau for publication as a notice in the
    25     Pennsylvania Bulletin.
    26         (3)  Every pharmacy selling pharmaceuticals at retail in
    27     this Commonwealth shall submit to the council for inclusion
    28     in the drug price registry, in a form and manner prescribed
    29     by the council, on the 10th day of each calendar month
    30     beginning with the first calendar month following publication
    20070H0700B1011                 - 52 -     

     1     of the list described in paragraph (2), its prior monthly
     2     retail prices for each drug on the list and its generic
     3     equivalent, together with the amount of the dispensing fee.
     4     In addition, each such pharmacy shall make the list and its
     5     prices available to its customers at the pharmacy retail site
     6     upon request.
     7             (i)  Each pharmacy retail site shall post a sign that
     8         notifies customers of the availability of its price list
     9         in a conspicuous location that is either at or adjacent
    10         to the place where prescriptions are presented for
    11         compounding and dispensing, in the customer waiting area
    12         or in the area where prescribed drugs are delivered.
    13             (ii)  The provisions of this paragraph shall not be
    14         construed to prevent a pharmacy from changing its current
    15         retail price at any time, provided that the listed price
    16         available at the pharmacy retail site is updated at least
    17         weekly to reflect the new retail price.
    18         (4)  The State Board of Pharmacy may impose a fine of up
    19     to $1,000 per day for each day that a pharmacy fails to
    20     comply with any of the provisions of this paragraph. A
    21     separate fine may be imposed for each failure to comply. All
    22     fines shall be due 30 days from receipt of notice of each
    23     such failure. Funds collected pursuant to this paragraph
    24     shall be deposited into the CAP Fund.
    25     (b)  The Pennsylvania Hospital Payment Registry.--
    26         (1)  The council shall also establish and maintain a
    27     registry to be known as the Pennsylvania Hospital Payment
    28     Registry for the purpose of making readily available to
    29     consumers information regarding the payments received by
    30     hospitals for the 150-most-frequent admission diagnoses and
    20070H0700B1011                 - 53 -     

     1     the 150-most-frequently dispensed drugs.
     2             (i)  The hospital payment registry shall include the
     3         information submitted to the council under this
     4         subsection and the name and address of each hospital
     5         providing the information and shall be organized by zip
     6         code.
     7             (ii)  The hospital payment registry shall be updated
     8         annually by the council and shall be posted on the
     9         council's Internet website in a format that is conducive
    10         to review and comparison by consumers of reimbursement
    11         data from hospitals in each zip code of this
    12         Commonwealth. It shall include a toll-free telephone
    13         number maintained by the council that consumers may call
    14         to obtain reprints of the registry.
    15             (iii)  The website shall be designed so that the
    16         consumer may download and print the displayed information
    17         and shall include at least the following:
    18                 (A)  Internet web links to other government
    19             resources that provide information relating to the
    20             regulation of hospitals and health insurance.
    21                 (B)  Clearly understandable language that is
    22             designed to assist consumers in understanding the
    23             content of and how to access the information made
    24             available on the website pursuant to this subsection.
    25             (iv)  The information on the hospital payment
    26         registry may be combined with other data collected by the
    27         council and posted on the council's Internet website to
    28         provide comparative information useful to consumers
    29         selecting a hospital for medical care.
    30         (2)  Within 90 days following the effective date of this
    20070H0700B1011                 - 54 -     

     1     section and on or before January 31 of each year thereafter,
     2     all hospitals shall submit to the council for inclusion in
     3     the hospital payment registry, in a form and manner
     4     prescribed by the council, all of the following:
     5             (i)  The 150-most-frequent admission diagnoses and
     6         the 150-most-frequently dispensed drugs (both
     7         prescription and nonprescription) in the hospital during
     8         the preceding year.
     9             (ii)  The amount an individual enrolled in a high
    10         deductible health plan with a health savings account is
    11         required to pay for the diagnoses and drugs described in
    12         subparagraph (i).
    13             (iii)  The average payment the hospital has
    14         negotiated with third-party payers for the diagnoses and
    15         drugs described in subparagraph (i).
    16             (iv)  The amount an uninsured patient is charged for
    17         the diagnoses and drugs described in subparagraph (i).
    18         (3)  A hospital shall make the list and payments received
    19     available to its patients at the hospital site upon request.
    20     The hospital shall post a sign that notifies patients of the
    21     availability of the list at or adjacent to the place where
    22     patients are admitted to the hospital and at the place where
    23     patients receive financial counseling.
    24     (c)  The Pennsylvania Outpatient Procedure Payment
    25  Registry.--
    26         (1)  The council shall also establish and maintain a
    27     registry to be known as the Pennsylvania Outpatient Procedure
    28     Payment Registry for the purpose of making readily available
    29     to consumers information regarding the payments received by
    30     ambulatory surgical facilities and imaging centers for the
    20070H0700B1011                 - 55 -     

     1     50-most-frequent outpatient procedures.
     2             (i)  The outpatient procedure payment registry shall
     3         include the information submitted to the council under
     4         this subsection and the name and address of each
     5         outpatient facility providing the information and shall
     6         be organized by zip code.
     7             (ii)  The outpatient procedure payment registry shall
     8         be updated annually by the council and shall be posted on
     9         the council's Internet website in a format that is
    10         conducive to review and comparison by consumers of
    11         reimbursement data from outpatient facilities in each zip
    12         code of this Commonwealth. It shall include a toll-free
    13         telephone number maintained by the council that consumers
    14         may call to obtain reprints of the registry.
    15             (iii)  The website shall be designed so that the
    16         consumer may download and print the displayed information
    17         and shall include at least the following:
    18                 (A)  Internet web links to other government
    19             resources that provide information relating to the
    20             regulation of outpatient facilities and health
    21             insurance.
    22                 (B)  Clearly understandable language that is
    23             designed to assist consumers in understanding the
    24             content of and how to access the information made
    25             available on the website pursuant to this subsection.
    26             (iv)  The information on the outpatient procedure
    27         payment registry may be combined with other data
    28         collected by the council and posted on the council's
    29         Internet website to provide comparative information
    30         useful to consumers selecting a provider of medical care.
    20070H0700B1011                 - 56 -     

     1         (2)  Within 90 days following the effective date of this
     2     section and on or before January 31 of each year thereafter,
     3     all ambulatory surgical facilities and all imaging centers
     4     shall submit to the council for inclusion in the outpatient
     5     procedure payment registry, in a form and manner prescribed
     6     by the council, the 50-most-frequent procedures performed at
     7     the ambulatory surgical facility or imaging center during the
     8     preceding year, the charge for each such procedure and the
     9     average third-party reimbursement for each such procedure.
    10         (3)  The council, in consultation with the Department of
    11     Health, may determine that the same information should be
    12     obtained from other health care providers that primarily
    13     perform outpatient procedures other than for primary or
    14     chronic care, and, 90 days following publication of notice in
    15     the Pennsylvania Bulletin, those health care providers shall
    16     submit to the council for inclusion in the outpatient
    17     procedure payment registry the information set forth in
    18     paragraph (2).
    19     (d)  Guidelines.--The council may adopt guidelines to
    20  effectuate the purposes of this section.
    21     (e)  Enforcement.--In addition to any other remedy available,
    22  the council may impose a civil penalty of up to $500 per day for
    23  each failure of a facility to provide the council the
    24  information required under this section. All fines collected
    25  under this subsection shall be deposited in the CAP Fund.
    26                             CHAPTER 73
    27                           ACCESSIBILITY
    28  Sec.
    29  7301.  Definitions.
    30  7302.  Pennsylvania Center for Health Careers.
    20070H0700B1011                 - 57 -     

     1  7303.  Health care provider practice.
     2  7304.  Hospice licensure.
     3  § 7301.  Definitions.
     4     The following words and phrases, when used in this chapter,
     5  shall have the meanings given to them in this section unless the
     6  context clearly indicates otherwise:
     7     "Center."  The Pennsylvania Center for Health Careers
     8  established under section 7302 (relating to Pennsylvania Center
     9  for Health Careers).
    10     "Certified registered nurse anesthetist."  A registered nurse
    11  certified by the State Board of Nursing to administer anesthesia
    12  and who meets the requirements of section 7303(j) (relating to
    13  health care provider practice).
    14     "Clinical nurse specialist."  An individual who is licensed
    15  by the State Board of Nursing and holds:
    16         (1)  A graduate degree, master's degree, doctoral degree,
    17     or post-master's certificate from an educational program that
    18     is recognized by the State Board of Nursing or a national
    19     nursing accrediting body accepted by the board and that
    20     prepares graduates to practice as a clinical nurse
    21     specialist.
    22         (2)  A national certification as a clinical nurse
    23     specialist in a designated specialty or in an area pertinent
    24     to the designated specialty or meets equivalence requirements
    25     as specified in regulations of the State Board of Nursing
    26     when there is no certification examination available in the
    27     clinical nurse specialist specialty area.
    28     "CODA."  American Dental Association's Commission on Dental
    29  Accreditation.
    30     "Collaboration."  A relationship between or among health care
    20070H0700B1011                 - 58 -     

     1  providers to deliver health care services with each contributing
     2  their expertise within the scope of their license, education and
     3  training. In the case of collaboration between a physician or
     4  dentist and a certified registered nurse practitioner, nurse
     5  midwife, clinical nurse specialist, certified registered nurse
     6  anesthetist or physician's assistant, the process allows the
     7  health care provider to perform acts of medical diagnosis and,
     8  pursuant to a collaborative or written agreement, to prescribe
     9  medical therapeutic and corrective measures. Collaboration
    10  includes all of the following:
    11         (1)  Immediate availability of a licensed physician or
    12     dentist to the health care provider through direct
    13     communications or by radio, telephone or telecommunications.
    14         (2)  A predetermined plan for emergency services.
    15         (3)  A physician or dentist available to the health care
    16     provider on a regularly scheduled basis for referrals, review
    17     of the standards of clinical practice incorporating
    18     consultation and chart review, review of drug and other
    19     clinical protocols within the practice setting, periodic
    20     updating in diagnosis and therapeutics and cosigning records
    21     when necessary to document accountability by both parties.
    22     "Collaborative or written agreement."  An agreement between a
    23  physician and a health care provider that is not a physician
    24  where such an agreement has been required under law for the
    25  health care provider to provide health care services.
    26     "Debridement."  The removal of dental calculus from teeth.
    27     "Department."  The Department of Labor and Industry of the
    28  Commonwealth.
    29     "Expanded primary care availability."  The provision of
    30  primary and urgent care during evenings and weekends on a walk-
    20070H0700B1011                 - 59 -     

     1  in or same-day appointment basis.
     2     "General supervision."  Supervision by a dentist who has
     3  authorized dental hygiene services for a patient to be
     4  administered in accordance with the dentist's diagnosis and
     5  treatment plan without the dentist being present, including
     6  being present in the treatment location.
     7     "Health care worker."  An employee, independent contractor,
     8  licensee or other individual authorized to provide health care
     9  services in a health care facility or who is engaged in public
    10  health activities.
    11     "Independent dental hygiene practitioner."  A dental
    12  hygienist who performs educational, preventative, therapeutic
    13  and intra-oral procedures which the hygienist is educated to
    14  perform and which require the hygienist's professional
    15  competence and skill but which do not require the professional
    16  competence and skill of a dentist without the authorization,
    17  assignment or examination of a dentist, and who is certified by
    18  the State Board of Dentistry as having satisfied the
    19  requirements of section 7303(h) (relating to health care
    20  provider practice).
    21     "Leadership council."  The Health Careers Leadership Council
    22  established under section 7302 (relating to Pennsylvania Center
    23  for Health Careers).
    24     "Local anesthesia."  A drug administered by injection in the
    25  mouth to temporarily eliminate or diminish the sensation of pain
    26  during routine dental care.
    27     "Nurse midwife."  An individual licensed by the State Board
    28  of Medicine to practice midwifery.
    29     "Physician assistant."  An individual certified as a
    30  physician assistant by the State Board of Medicine.
    20070H0700B1011                 - 60 -     

     1     "Primary care."  The provision of family, adult, pediatric,
     2  men's or women's health care services or chronic care management
     3  at a point of entry to the health care system other than an
     4  emergency room.
     5     "Primary care provider."  A licensee who is a physician,
     6  physician assistant, certified registered nurse practitioner,
     7  clinical nurse specialist practicing primary care, nurse midwife
     8  or any group practice consisting of some or all of the
     9  foregoing.
    10     "Radiologic procedure."  A medical or dental procedure, such
    11  as an X-ray, that uses radiation or other sources to create
    12  images useful in diagnosis.
    13     "Secretary."  The Secretary of Labor and Industry.
    14     "Soft tissue curettage."  The removal of soft tissue in the
    15  mouth with a curette.
    16  § 7302.  Pennsylvania Center for Health Careers.
    17     (a)  Establishment.--The Pennsylvania Center for Health
    18  Careers is hereby established within the department. The center
    19  will provide a focused direction and purpose for the development
    20  of strategies to address the Commonwealth's short-term and long-
    21  term health care work force challenges to ensure the quality and
    22  supply of such work force by:
    23         (1)  Increasing the capacity of nursing education in this
    24     Commonwealth.
    25         (2)  Retaining health care workers.
    26         (3)  Increasing diversity of health care workers.
    27         (4)  Responding to the demand for allied health
    28     professionals that provide critical care.
    29         (5)  Addressing the needs of direct care workers.
    30     (b)  Powers and duties.--The center shall have the following
    20070H0700B1011                 - 61 -     

     1  powers and duties:
     2         (1)  Determine the health care work force needs of this
     3     Commonwealth through research, outreach and study.
     4         (2)  Research best practices in addressing similar work
     5     force needs in other states.
     6         (3)  Assess the effectiveness of the initiatives,
     7     programs and projects the center undertakes.
     8         (4)  Assist and implement the initiatives and strategies
     9     of the council.
    10         (5)  Develop recruitment and workplace tools that assist
    11     health care facilities to increase the diversity of their
    12     work force and promote the delivery of culturally appropriate
    13     care.
    14         (6)  Assess the current capacity of medical education
    15     within the Commonwealth's medical schools and training
    16     programs.
    17         (7)  Assess current and needed efforts addressing
    18     recruitment and retention of physicians and other health care
    19     professionals.
    20     (c)  Leadership council.--The center shall be governed by the
    21  Health Careers Leadership Council which shall consist of the
    22  following members:
    23         (1)  The secretary, the Secretary of State, the Secretary
    24     of Health, the Secretary of Public Welfare or their
    25     designees.
    26         (2)  Four members of the General Assembly:
    27             (i)  Two members of the Senate, one appointed by the
    28         President pro tempore of the Senate and one appointed by
    29         the Minority Leader of the Senate.
    30             (ii)  Two members of the House of Representatives,
    20070H0700B1011                 - 62 -     

     1         one appointed by the Speaker of the House of
     2         Representatives and one appointed by the Minority Leader
     3         of the House of Representatives.
     4         (3)  Additional members that are representatives of
     5     health care-related professionals and organizations,
     6     including employers, employees and educators, in such number
     7     as may be determined by the Governor and to be appointed by
     8     the Governor in consultation with the Pennsylvania Workforce
     9     Investment Board created by the act of December 18, 2001
    10     (P.L.949, No.114), known as the Workforce Development Act.
    11         (4)  Members of the leadership council shall serve at the
    12     pleasure of their respective appointing authorities. Members
    13     shall not receive compensation for their service as members
    14     of the council but shall be reimbursed for reasonable and
    15     necessary expenses in the performance of their duties in
    16     accordance with Commonwealth policy with the approval of the
    17     secretary.
    18         (5)  The Governor shall designate a member or members of
    19     the leadership council to serve as chair or cochairs.
    20         (6)  The leadership council shall have the following
    21     powers and duties:
    22             (i)  Determine the organization, procedures and
    23         priorities of the center.
    24             (ii)  Develop initiatives, programs and projects for
    25         the center to address the health care work force needs of
    26         the Commonwealth.
    27             (iii)  Apply for grants and seek other revenue
    28         sources, including General Fund appropriations through
    29         the department's budget.
    30             (iv)  Do all other acts necessary to carry out the
    20070H0700B1011                 - 63 -     

     1         purposes and policies of this section.
     2     (d)  Administration.--The department shall provide
     3  administrative support to the leadership council. The center
     4  shall use and have access to any information, services,
     5  functions and other resources in the possession of Commonwealth
     6  agencies deemed necessary to the fulfillment of its
     7  responsibilities under this section.
     8  § 7303.  Health care provider practice.
     9     (a)  General rule.--Except with respect to those laws or
    10  regulations applying to the medical staff of a hospital or the
    11  oversight of inpatient clinical services performed in a
    12  hospital, wherever in any law or regulation of the Commonwealth
    13  the terms "physician," "medical doctor," "doctor of osteopathy,"
    14  "dentist" or similar term is used to define an individual who
    15  shall take medical histories, perform physical or mental
    16  examinations or provide acute illness, minor injury or chronic
    17  disease management care, those terms shall be deemed to include
    18  certified registered nurse practitioners, clinical nurse
    19  specialists, physician assistants, nurse midwives and
    20  independent dental hygienist practitioners; provided that such
    21  activities fall within the individual's specialty certification
    22  and scope of practice as determined by the applicable State
    23  licensing board.
    24     (b)  Professional liability.--A certified registered nurse
    25  practitioner, clinical nurse specialist, nurse midwife or
    26  physician assistant practicing in this Commonwealth whose
    27  employer does not provide professional liability coverage shall
    28  maintain a level of professional liability coverage required by
    29  law of a physician providing similar health care services in
    30  this Commonwealth, but shall not be eligible to participate in
    20070H0700B1011                 - 64 -     

     1  the fund established under Mcare.
     2     (c)  Collaborative and written agreements.--
     3         (1)  There shall be no limit to the number of certified
     4     registered nurse practitioners with prescriptive authority or
     5     physician assistants for whom a physician has responsibility
     6     or supervises under a collaborative or written agreement at
     7     any time.
     8         (2)  Collaborative and written agreements shall not
     9     unreasonably restrict any health care provider's ability to
    10     practice to the fullest extent permitted by his scope of
    11     practice, clinical education and experience.
    12         (3)  The Department of State, Bureau of Professional and
    13     Occupational Affairs, shall accept complaints in a form and
    14     manner prescribed by the bureau with respect to the
    15     following:
    16             (i)  the unwillingness of physicians in a given
    17         geographic area to enter into an agreement with any
    18         member of a class of health care providers; or
    19             (ii)  any unduly restrictive provisions contained in
    20         an agreement.
    21     The bureau shall establish a process for resolving complaints
    22     it determines are credible, including required mediation
    23     among the parties.
    24         (4)  The provisions of 49 Pa. Code §§ 18.57 (relating to
    25     physician supervision) and 21.287 (relating to physician
    26     supervision) are abrogated to the extent such provisions
    27     restrict the number of certified registered nurse
    28     practitioners a physician may supervise at any time. The
    29     provisions of 49 Pa. Code § 18.152(b)(2) (relating to
    30     prohibitions) are abrogated to the extent that the number of
    20070H0700B1011                 - 65 -     

     1     physician assistants for which a physician may have primary
     2     responsibility is restricted.
     3     (d)  Certified registered nurse practitioners.--Except as
     4  limited by the scope of his specialty certification or in a
     5  collaborative or written agreement:
     6         (1)  A certified registered nurse practitioner shall not
     7     be limited in prescribing any drug, including a controlled
     8     substance on Schedules II through V, nor shall there be any
     9     limit on the number of refills or dosages except as may be
    10     provided under Federal law, except that the certified
    11     registered nurse practitioner shall use his own Drug
    12     Enforcement Administration number and not that of any
    13     collaborating physician in writing the prescription.
    14         (2)  In addition to existing authority, a certified
    15     registered nurse practitioner shall have authority to do all
    16     of the following:
    17             (i)  Order home health and hospice care.
    18             (ii)  Order durable medical equipment.
    19             (iii)  Issue oral orders under the same conditions
    20         and in the same facilities as physicians are permitted to
    21         do.
    22             (iv)  Perform and sign workers compensation
    23         physicals.
    24             (v)  Perform physical therapy and dietitian
    25         referrals.
    26             (vi)  Order respiratory or occupational therapy.
    27             (vii)  Perform disability assessments for the program
    28         providing Temporary Assistance to Needy Families.
    29             (viii)  Perform and sign methadone treatment
    30         evaluations.
    20070H0700B1011                 - 66 -     

     1             (ix)  Perform and sign cosmetology license physicals.
     2             (x)  Issue home schooling certifications.
     3             (xi)  Make commitments under the act of July 9, 1976
     4         (P.L.817, No.143), known as the Mental Health Procedures
     5         Act.
     6             (xii)  Perform and sign psychiatric evaluations.
     7             (xiii)  Perform other similar activities.
     8     (e)  Nurse midwives.--Notwithstanding the provisions of any
     9  other law or regulation:
    10         (1)  A nurse midwife is authorized to provide and manage
    11     primary health care of women during pregnancy, childbirth,
    12     and the postpartum period, provide care of the neonate and
    13     provide office gynecological care and family planning
    14     services.
    15         (2)  A nurse midwife may, consistent with the midwife's
    16     academic educational preparation and national certification,
    17     prescribe, dispense, order and administer the following:
    18             (i)  Legend drugs and Schedule II through Schedule V
    19         controlled substances provided that the midwife:
    20                 (A)  Has successfully completed at least 45 hours
    21             of coursework specific to advanced pharmacology at a
    22             level above that required by a professional nursing
    23             education program.
    24                 (B)  In the two years prior to the biennial
    25             renewal of the nurse midwife's license, successfully
    26             completes at least 16 hours of continuing education
    27             in pharmacology approved by the State Board of
    28             Medicine. The nurse midwife shall provide the board
    29             with evidence that the nurse midwife has completed
    30             such training as part of the biennial renewal
    20070H0700B1011                 - 67 -     

     1             process.
     2                 (C)  Acts in collaboration with a physician as
     3             set forth in a written agreement which shall at a
     4             minimum identify the categories of drugs from which
     5             the nurse midwife may prescribe or dispense and the
     6             circumstances under which the collaborating physician
     7             will personally see the patient.
     8                 (D)  Acts in accordance with regulations
     9             promulgated by the State Board of Medicine, which
    10             shall not unreasonably restrict the midwife's
    11             practice.
    12             (ii)  Medical devices.
    13             (iii)  Immunizing agents.
    14             (iv)  Laboratory tests.
    15             (v)  Therapeutic, diagnostic and preventative
    16         measures.
    17     (f)  Clinical nurse specialists.--Any individual who holds a
    18  license to practice professional nursing in this Commonwealth
    19  who meets the requirements to be a clinical nurse specialist
    20  shall have the right to use the title "clinical nurse
    21  specialist" and the abbreviation "CNS." No other individual
    22  shall have that right.
    23     (g)  Dental hygienists.--
    24         (1)  Classifications developed by the American Society of
    25     Anesthesiologists shall not be a factor in determining the
    26     level of supervision required by dental hygienists. The
    27     supervising dentist and the dental hygienist shall determine
    28     the appropriate level of supervision for each patient based
    29     on the patient's health and history.
    30         (2)  In addition to existing authority, a dental
    20070H0700B1011                 - 68 -     

     1     hygienist may perform the following in any setting under the
     2     general supervision of a dentist:
     3             (i)  Radiologic procedures.
     4             (ii)  Debridement.
     5             (iii)  Soft tissue curettage.
     6             (iv)  Suture removal.
     7             (v)  Teeth filling.
     8         (3)  A dental hygienist may administer local anesthesia
     9     under the following conditions:
    10             (i)  The dental hygienist holds a current license in
    11         good standing, is certified in basic life support and has
    12         provided the board documentation evidencing one of the
    13         following:
    14                 (A)  Graduation within the five years immediately
    15             preceding the filing of the application from a dental
    16             hygiene school accredited by CODA, which included the
    17             successful completion of a course in the
    18             administration of local anesthesia.
    19                 (B)  Successful completion within the five years
    20             immediately preceding the filing of the application
    21             of a course consisting of a minimum of 30 hours of
    22             instruction in the administration of local anesthesia
    23             sponsored by an education program accredited by CODA.
    24                 (C)  Possession of a current license or permit
    25             issued by the proper licensing authority of another
    26             state, territory or district, or by Canada, where the
    27             dental hygienist is authorized under the laws of that
    28             jurisdiction to administer local anesthesia, provided
    29             that the dental hygienist has been actively engaged
    30             in the administration of local anesthesia within the
    20070H0700B1011                 - 69 -     

     1             five years immediately preceding the filing of the
     2             application and that the applicable jurisdiction
     3             required, as a condition of receiving the license or
     4             permit, that the dental hygienist complete a course
     5             in the administration of local anesthesia accredited
     6             by CODA or its Canadian counterpart.
     7             (ii)  The dental hygienist has applied for and
     8         received a permit from the State Board of Dentistry and
     9         paid any required permit fee.
    10         (4)  In addition to other locations set forth in law, a
    11     dental hygienist may provide dental services in free clinics.
    12     (h)  Independent dental hygiene practitioners.--
    13         (1)  An independent dental hygiene practitioner must be
    14     certified by the State Board of Dentistry upon meeting the
    15     following criteria:
    16             (i)  completion of 1,800 hours of practice under the
    17         supervision of a dentist; and
    18             (ii)  purchase of a professional liability policy in
    19         an amount determined to be adequate by the board.
    20         (2)  Following certification by the State Board of
    21     Dentistry under paragraph (1), an independent dental hygiene
    22     practitioner may, without the supervision of a dentist:
    23             (i)  Perform any procedure a dental hygienist may
    24         perform.
    25             (ii)  Order and administer fluoride treatments and
    26         products, to include fluoride varnish, home fluoride
    27         treatment and other such fluoride-containing products as
    28         may be necessary to prevent dental caries.
    29             (iii)  Order dental equipment.
    30         (3)  An independent dental hygiene practitioner shall
    20070H0700B1011                 - 70 -     

     1     limit his professional practice to the following practice
     2     sites:
     3             (i)   Schools.
     4             (ii)  Correctional facilities.
     5             (iii)  Health care facilities.
     6             (iv)  "Personal care homes" as defined in section
     7         1001 of the Public Welfare Code.
     8             (v)  "Domiciliary care" as defined in section 2202-A
     9         of the act of April 9, 1929 (P.L.177, No.175), known as
    10         The Administrative Code of 1929.
    11             (vi)  An "older adult daily living center" as defined
    12         in section 2 of the act of July 11, 1990 (P.L.499,
    13         No.118), known as the Older Adult Daily Living Centers
    14         Licensing Act.
    15             (vii)  A "facility" as defined in section 3 of the
    16         act of June 18, 1984 (P.L.391, No.82), known as the
    17         Continuing-Care Provider Registration and Disclosure Act.
    18             (viii)  A public or private institution under the
    19         jurisdiction of a Federal, State or local agency.
    20             (ix)  Day-care centers as defined in Articles IX and
    21         X of the Public Welfare Code.
    22             (x)  Facilities operating Head Start programs
    23         established by the Omnibus Budget and Reconciliation Act
    24         of 1981 (Public Law 97-35, 95 Stat. 357).
    25             (xi)  Free clinics.
    26             (xii)  Other institutions the State Board of
    27         Dentistry deems appropriate.
    28     (i)  Pharmacists.--In addition to the activities authorized
    29  by the act of September 27, 1961 (P.L.1700, No.699), known as
    30  the Pharmacy Act, pharmacists may manage drug therapy in any
    20070H0700B1011                 - 71 -     

     1  integrated health setting such as academic health centers and
     2  group practice settings where the pharmacist is an integral
     3  member of the interdisciplinary clinical team and has access to
     4  the patient's medical record. In such practice settings, the
     5  pharmacist shall follow the same protocols and procedures as
     6  that required for drug therapy management in "institutions" as
     7  defined in the Pharmacy Act.
     8     (j)  Certified registered nurse anesthetists.--The State
     9  Board of Nursing shall certify a registered nurse as a certified
    10  registered nurse anesthetist if the nurse satisfies the
    11  requirements established by this subsection and any regulations
    12  promulgated by the board. The certification of a nurse under
    13  this subsection shall expire on the same date as the nurse's
    14  license expires.
    15         (1)  In order to be certified, a registered nurse must
    16     satisfy the following criteria:
    17             (i)  Completion of the educational program of a
    18         school for nurse anesthetists accredited by an
    19         accrediting agency recognized by the State Board of
    20         Nursing.
    21             (ii)  Receipt of certification as a certified
    22         registered nurse anesthetist by a board-recognized
    23         national certification organization.
    24         (2)  A registered nurse who is enrolled in an educational
    25     program of a school for nurse anesthetists accredited by an
    26     accrediting agency recognized by the State Board of Nursing
    27     may, during such enrollment, administer anesthesia under the
    28     direction of the chief or director of anesthesia services, an
    29     anesthesiologist or a certified registered nurse anesthetist.
    30         (3)  A registered nurse who has obtained the education
    20070H0700B1011                 - 72 -     

     1     required by this subsection but who has not yet obtained
     2     certification as a certified registered nurse anesthetist may
     3     administer anesthesia under the direction of the chief or
     4     director of anesthesia services, an anesthesiologist or a
     5     certified registered nurse anesthetist until the announcement
     6     of results of the first examination taken for certification
     7     for which the registered nurse is eligible. If the registered
     8     nurse fails to take or fails to pass that examination, the
     9     registered nurse shall immediately cease practicing as a
    10     nurse anesthetist, provided, however, that the registered
    11     nurse may appeal to the State Board of Nursing for authority
    12     to continue practicing as a nurse anesthetist if, due to
    13     extenuating circumstances, the registered nurse is unable to
    14     take the examination in a time period specified by the board
    15     following completion of the required education.
    16         (4)  A certified registered nurse anesthetist shall be
    17     subject to all of the following:
    18             (i)  A certified registered nurse anesthetist shall
    19         administer anesthesia in collaboration with a physician
    20         or dentist.
    21             (ii)  A certified registered nurse anesthetist's
    22         performance shall be under the overall direction of the
    23         chief or director of anesthesia services, provided,
    24         however, that in situations or health care facilities
    25         where anesthesia services are not mandatory, the
    26         certified registered nurse anesthetist's performance
    27         shall be under the overall direction of the collaborating
    28         physician or dentist.
    29             (iii)  When the operating or anesthesia team consists
    30         entirely of nonphysicians, an anesthesiologist or
    20070H0700B1011                 - 73 -     

     1         consulting physician of the certified registered nurse
     2         anesthetist's choice shall be available to the certified
     3         registered nurse anesthetist by physical presence or
     4         electronic communication.
     5         (5)  Nothing in this subsection shall be construed to
     6     prohibit the continued practice of certified registered nurse
     7     anesthetists who were authorized to practice in this
     8     Commonwealth on the effective date of this subsection.
     9     (k)  Health insurers.--An insurer issuing health insurance
    10  coverage within this Commonwealth is:
    11         (1)  Required to include the following classes of health
    12     care providers as primary care providers in each of its
    13     provider networks:
    14             (i)  certified registered nurse practitioners,
    15         physician assistants, clinical nurse specialists
    16         practicing in primary care and nurse midwives; and
    17             (ii)  urgent care, convenient care, nurse-managed
    18         care or federally qualified health centers if they are
    19         geographically available to provide services to those
    20         insured by the insurer.
    21     The Insurance Commissioner may modify the foregoing list from
    22     time to time by publication of a notice in the Pennsylvania
    23     Bulletin.
    24         (2)  Required to establish a credentialing process to
    25     enroll qualified health care providers to create an adequate
    26     provider network that includes the classes of health care
    27     providers required under paragraph (1). The process shall be
    28     submitted to the Department of Health for approval within 180
    29     days following the effective date of this section and shall
    30     be resubmitted to the Department of Health for approval every
    20070H0700B1011                 - 74 -     

     1     two years thereafter. The process shall include written
     2     criteria and procedures for initial enrollment, renewal,
     3     restrictions and termination of credentials for health care
     4     providers, disclose relevant credentialing criteria and
     5     procedures to health care providers that apply to participate
     6     or that are participating in the insurer's provider network
     7     and provide any health care provider denied credentials or
     8     renewal of credentials with timely written notice containing
     9     a clear explanation of the reason for the denial.
    10         (3)  Required to timely pay health care providers for
    11     health care services at rates sufficient to assure the
    12     availability of and access to adequate health care providers
    13     in all networks, taking into account the need for fiscal
    14     restraint.
    15         (4)  Required to pay health care providers incentives for
    16     providing expanded primary care availability.
    17         (5)  Required to pay a primary care provider and
    18     certified registered nurse anesthetist directly for services
    19     provided unless the provider or certified registered nurse
    20     anesthetist notifies the insurer otherwise.
    21         (6)  Required to pay certified registered nurse
    22     practitioners, clinical nurse specialists, physician
    23     assistants and nurse midwives as primary care providers for
    24     primary care services and reasonable rates for providing
    25     specialty health care services that are within their scope of
    26     practice to provide.
    27         (7)  Prohibited from excluding minor children with
    28     behavioral health conditions from coverage or excluding from
    29     covered services behavioral therapy services for minor
    30     children.
    20070H0700B1011                 - 75 -     

     1  § 7304.  Hospice licensure.
     2     (a)  Regulations.--Within 180 days following the effective
     3  date of this section, the Department of Health shall promulgate
     4  proposed regulations, and within 270 days following the
     5  effective date of this section the Department of Health shall
     6  promulgate final regulations for licensure of residential
     7  hospice facilities which shall include licensure of the
     8  following:
     9         (1)  small residential hospices with 22 or fewer beds;
    10     and
    11         (2)  hospices for children or units for children within
    12     licensed hospices or other health care facilities provided
    13     that the children's hospice units are physically separated
    14     and secured from units providing services to adults.
    15     (b)  Alternative.--In developing its regulations, the
    16  Department of Health shall establish for small residential
    17  hospices an alternative to the fire and safety regulations for
    18  hospices certified as providers of the Medicare program under
    19  Title XVIII of the Social Security Act (49 Stat. 620, U.S.C. §
    20  1395 et seq.) that currently require hospices to meet standards
    21  for nursing homes contained in the 2000 edition of the Life
    22  Safety Code of the National Fire Protection Association. In
    23  developing the alternative, the Department of Health shall
    24  consider as a minimum the requirements for large board and care
    25  occupancies set forth in the 2006 edition of the Life Safety
    26  Code.
    27                             CHAPTER 74
    28               QUALITY OF CARE AND HEALTHY LIFESTYLES
    29  Sec.
    30  7401.  Definitions.
    20070H0700B1011                 - 76 -     

     1  7402.  Patient safety.
     2  7403.  Smoking restrictions.
     3  § 7401.  Definitions.
     4     The following words and phrases when used in this chapter
     5  shall have the meanings given to them in this section unless the
     6  context clearly indicates otherwise:
     7     "Authority."  The Patient Safety Authority established under
     8  Mcare.
     9     "Bar."  Any area, including outdoor seating areas, devoted to
    10  the sale and service of alcoholic beverages for on-premises
    11  consumption and where the service of food is only incidental to
    12  the consumption of such beverages.
    13     "Consumer Price Index."  The Consumer Price Index for All
    14  Urban Consumers (CPI-U) for the Pennsylvania, New Jersey,
    15  Delaware and Maryland area, for the most recent 12-month period
    16  for which figures have been officially reported by the United
    17  States Department of Labor, Bureau of Labor Statistics,
    18  immediately prior to the subject date.
    19     "Department."  The Department of Health of the Commonwealth.
    20     "Enforcement officer."  The board of health of a county or an
    21  officer designated under section 7403(g) (relating to smoking
    22  restrictions).
    23     "Food service establishment."  Any area, including outdoor
    24  seating areas, or portion of an area in which the business is
    25  the sale of food for on-premises consumption.
    26     "Health-care-acquired-infection."  An infection acquired in a
    27  health care facility.
    28     "Impaired professional program."  The program established
    29  under the act of December 20, 1985 (P.L.457, No.112), known as
    30  the Medical Practice Act of 1985.
    20070H0700B1011                 - 77 -     

     1     "MRSA."  Methicillin-resistant staphylococcus aureus, a more
     2  serious form of bacterial health-care-acquired infection that is
     3  resistant to commonly used antibiotics.
     4     "Patient safety report."  The Patient Safety and Quality
     5  Improvement Report required under section 7402(f) (relating to
     6  patient safety).
     7     "Places of employment."  An indoor area or portion of an
     8  indoor area under the control of an employer in which employees
     9  of the employer perform services. The term includes offices,
    10  school grounds, retail stores, banquet facilities, theaters,
    11  food stores, banks, financial institutions, factories,
    12  warehouses, employee cafeterias, lounges, auditoriums,
    13  gymnasiums, restrooms, elevators, hallways, museums, libraries,
    14  bowling establishments, employee medical facilities, rooms or
    15  areas containing photocopying equipment or other office
    16  equipment used in common and company vehicles.
    17     "Retail tobacco business."  A sole proprietorship, limited
    18  liability company, corporation, partnership or other enterprise
    19  in which the primary activity is the retail sale of tobacco
    20  products and accessories and in which the sale of other products
    21  is merely incidental.
    22     "Safe practices."  The set of standards endorsed by the
    23  National Quality Forum that should be used by health care
    24  providers to reduce the risk of harm to patients.
    25     "School grounds."  A building, structure and surrounding
    26  outdoor grounds contained within a public or private preschool,
    27  nursery school, elementary or secondary school's legally defined
    28  property boundaries and any vehicles used to transport children
    29  or school personnel.
    30     "Smoking."  The burning of a lighted cigar, cigarette, pipe
    20070H0700B1011                 - 78 -     

     1  or any other matter or substance which contains tobacco.
     2  § 7402.  Patient safety.
     3     (a)  Electronic surveillance of health-care-acquired
     4  infections.--
     5         (1)  By September 1, 2008, all hospitals shall use a
     6     uniform electronic surveillance system to report health-care-
     7     acquired infections to the council in a form and manner
     8     prescribed by the council. The system shall provide for all
     9     of the following:
    10             (i)  Extraction of existing electronic clinical data
    11         from hospital systems on an ongoing basis.
    12             (ii)  Translation of nonstandardized laboratory data
    13         into uniform information that can be analyzed on a
    14         population-wide basis.
    15             (iii)  Clinical support, educational tools and
    16         training to ensure that information provided under this
    17         paragraph will lead to change.
    18             (iv)  Clinical improvement measurement and the
    19         structure to provide ongoing positive and negative
    20         feedback to hospital staff who implement change.
    21         (2)  Within 30 days following the effective date of this
    22     section, the council shall identify and certify a specific
    23     system or systems that meet the criteria described in
    24     paragraph (1) and shall forward the identity of the certified
    25     system or systems to the Legislative Reference Bureau for
    26     publication as a notice in the Pennsylvania Bulletin.
    27     (b)  Reporting emergency services.--The council, in
    28  consultation with the department, shall determine the manner and
    29  scope of reporting to the council that hospitals shall undertake
    30  with respect to individuals presenting at hospitals for
    20070H0700B1011                 - 79 -     

     1  emergency services. The council shall forward requirements
     2  concerning the reporting, including the date the reporting is to
     3  commence, to the Legislative Reference Bureau for publication as
     4  a notice in the Pennsylvania Bulletin. After the date the
     5  reporting is to commence, compliance with the requirements shall
     6  be a condition of licensure for hospitals.
     7     (c)  Reporting by nursing homes.--Nursing homes shall report
     8  to the council the same infections and in the same manner that
     9  hospitals are required to report to the council under the Health
    10  Care Cost Containment Act. Reporting shall begin within 30 days
    11  following the effective date of this section. For purposes of
    12  this section, nursing homes shall be additional data sources as
    13  defined in the Health Care Cost Containment Act, and covered
    14  services, as defined in that act, shall include those services
    15  provided by nursing homes.
    16     (d)  Analysis of nursing home data by Patient Safety
    17  Authority.--
    18         (1)  At the request of the department, but no less
    19     frequently than once per year, the authority shall analyze
    20     data without patient identifying information reported to the
    21     department by nursing homes with respect to events
    22     compromising patient safety as required by 28 Pa. Code § 51.3
    23     (relating to notification).
    24         (2)  The authority shall conduct analyses as it
    25     determines are appropriate to provide information to nursing
    26     homes which can be used to improve patient safety and quality
    27     of care.
    28         (3)  The authority shall provide nursing homes with
    29     patient safety advisories issued by the authority and permit
    30     any nursing home administrator to attend any patient safety
    20070H0700B1011                 - 80 -     

     1     training program it offers.
     2         (4)  Nursing homes shall pay the department a surcharge
     3     on their licensing fees to provide sufficient revenues to the
     4     authority for its responsibilities under this section. The
     5     department shall determine the proportionate share to be paid
     6     by each nursing home on a per-bed basis within 60 days
     7     following the effective date of this section.
     8             (i)  The total surcharge for all nursing homes shall
     9         not exceed $1,000,000 in fiscal year 2007-2008 and shall
    10         be increased by the Consumer Price Index in each
    11         succeeding fiscal year. All surcharges shall be paid by
    12         the end of each fiscal year.
    13             (ii)  The department shall transfer the total
    14         surcharges collected to the Patient Safety Trust Fund
    15         within 30 days of receipt.
    16             (iii)  In the event that the Patient Safety Trust
    17         Fund is discontinued or the authority is dissolved, any
    18         balance of the surcharges paid by nursing homes remaining
    19         in the Patient Safety Trust Fund, after deducting
    20         administrative costs of liquidation, shall be returned to
    21         the nursing homes in proportion to their financial
    22         contributions to the Patient Safety Trust Fund in the
    23         preceding licensing period.
    24             (iv)  If, after 30 days' notice, a nursing home fails
    25         to pay a surcharge levied by the department under this
    26         subsection, the department may assess an administrative
    27         penalty of $1,000 per day until the surcharge is paid.
    28         The penalty shall be imposed from the date of the notice
    29         and deposited into the CAP Fund.
    30     (e)  E-prescribing.--
    20070H0700B1011                 - 81 -     

     1         (1)  Within 60 days following the effective date of this
     2     section, each health care facility shall develop a full and
     3     complete implementation plan with specific goals, key
     4     performance indicators and timelines in order to meet the
     5     following requirements:
     6             (i)  Commencing September 1, 2008, a health care
     7         facility shall provide easy and timely access to an e-
     8         prescribing system for all of its staff, employees or
     9         contractors who have prescriptive authority in this
    10         Commonwealth and who write prescriptions for patients of
    11         the health care facility in order to allow them to write
    12         prescriptions electronically and check for potentially
    13         harmful drug interactions.
    14             (ii)  Thereafter, the health care facility shall
    15         certify to the department on its application for license
    16         or license renewal that it provides access for all staff,
    17         employees and contractors with prescriptive authority to
    18         an e-prescribing system and requires its use.
    19         (2)  Within 60 days following the effective date of this
    20     section, the State Board of Medicine shall determine the date
    21     after which it will require physicians, as a condition of
    22     licensure, to use an e-prescribing system to write
    23     prescriptions electronically and check for potentially
    24     harmful drug interactions. The State Board of Medicine shall
    25     forward a notice of the date to the Legislative Reference
    26     Bureau for publication in the Pennsylvania Bulletin.
    27     Effective as of that date, the State Board of Medicine shall
    28     require a physician to certify on the physician's application
    29     for license or license renewal that the physician has access
    30     to and uses an e-prescribing system.
    20070H0700B1011                 - 82 -     

     1         (3)  (i)  Any false or misleading statement on a
     2         certification by a health care facility shall subject the
     3         health care facility to a civil penalty of $5,000 per
     4         instance, which shall be imposed and collected by the
     5         department and deposited into the CAP Fund.
     6             (ii)  Any false or misleading statement on a
     7         certification by a physician shall subject the physician
     8         to a civil penalty of $5,000 per instance, which shall be
     9         imposed and collected by the State Board of Medicine and
    10         deposited into the CAP Fund.
    11         (4)  Notwithstanding any provision of law or regulation,
    12     oral orders for medication or treatment shall be issued or
    13     accepted only in emergency circumstances if no alternative
    14     method is available.
    15         (5)  Up to $25,000,000 of the funds appropriated by the
    16     General Assembly for the Machinery and Equipment Loan Fund
    17     shall be made available for grants to health care facilities
    18     to assist in acquiring the systems described under this
    19     subsection. Grants shall not exceed 50% of a hospital's
    20     costs, which shall be approved by the Department of Community
    21     and Economic Development. The Department of Community and
    22     Economic Development shall develop criteria for evaluating
    23     applications for grants that considers the fiscal condition
    24     of the hospital, the ability of the hospital to implement the
    25     technology and the potential savings through avoided costs
    26     and reduced errors. The criteria shall be forwarded by the
    27     Department of Community and Economic Development to the
    28     Legislative Reference Bureau for publication as a notice in
    29     the Pennsylvania Bulletin.
    30     (f)  Health care facilities annual report.--
    20070H0700B1011                 - 83 -     

     1         (1)  A hospital shall, on or before April 1 of each
     2     calendar year, submit to the department a Patient Safety and
     3     Quality Improvement Report for each facility that it
     4     operates. The patient safety report shall cover the prior
     5     calendar year and shall contain at least the following
     6     information:
     7             (i)  Three-year trends in the rates of health-care-
     8         acquired infections, medication errors, readmissions and
     9         procedure complications, failures to rescue and falls.
    10             (ii)  The recommendations of the authority and
    11         approved by the department under section 301 of Mcare
    12         that have been implemented at the hospital.
    13             (iii)  The specific safe practices that each hospital
    14         facility will adopt and implement during the next
    15         calendar year to reduce health-care-acquired infections,
    16         medication errors, readmissions and procedure
    17         complications, failures to rescue and falls.
    18             (iv)  Beginning with the second report submitted
    19         under this subsection and with each report submitted
    20         thereafter, the progress of implementation of safe
    21         practices adopted during the previous calendar year,
    22         whether the hospital will continue any of the practices
    23         and the reason the hospital will discontinue any safe
    24         practice previously adopted.
    25             (v)  The hospital's plan to implement facility-wide
    26         and data-driven error-reduction or quality improvement
    27         programs that the hospital intends to adopt and implement
    28         at each hospital facility, including a computer physician
    29         order entry system, medication bar coding and programs to
    30         identify and correct systemic causes of error and achieve
    20070H0700B1011                 - 84 -     

     1         reliable quality outcomes.
     2         (2)  Submission of the report shall be a condition of
     3     hospital licensure.
     4         (3)  The department may use information reported to it
     5     under paragraph (1) for the purposes of providing information
     6     to consumers and developing performance and quality standards
     7     and best practices and shall cooperate with the council in
     8     making the information available on a single consumer
     9     accessible Internet website that may be used by consumers for
    10     comparative purposes to determine where they wish to receive
    11     health care.
    12     (g)  Standards to reduce health-care-acquired infections and
    13  medical errors.--
    14         (1)  All hospitals and nursing homes shall adopt
    15     evidence-based universal screening of patients and residents
    16     for MRSA upon admission and randomized screening of
    17     inpatients, residents and staff. If a screening results in a
    18     positive culture, the patient or resident shall be isolated
    19     and the hospital or nursing home shall take all actions
    20     necessary to prevent the spread of MRSA to other inpatients,
    21     residents or staff. The department shall develop acceptable
    22     protocols for such screening and necessary isolation and
    23     treatment and forward them to the Legislative Reference
    24     Bureau for publication as a notice in the Pennsylvania
    25     Bulletin within 180 days following the effective date of this
    26     section.
    27         (2)  The department shall establish all of the following:
    28             (i)  Standardized best practices for health care
    29         facilities to adopt to eliminate health-care-acquired
    30         infections and medical errors and to maintain patient
    20070H0700B1011                 - 85 -     

     1         safety.
     2             (ii)  A date by which health care facilities shall
     3         adopt the standards as a condition of licensure.
     4         (3)  The department shall not issue or renew a license to
     5     a health care facility that fails to meet the requirements of
     6     this subsection and demonstrates that it has made substantial
     7     progress toward the elimination of health-care-acquired
     8     infections and medical errors.
     9     (h)  Patient safety training.--
    10         (1)  As a condition of receiving a license from the
    11     department under the Health Care Facilities Act and as a
    12     condition of continued licensure under that act, the
    13     following shall apply:
    14             (i)  Each hospital shall ensure that every licensee
    15         providing clinical services in the hospital, every chief
    16         executive officer, chief financial officer and chief
    17         medical officer, and every officer and director of the
    18         hospital board of directors receives at least six hours
    19         of in-person and monitored training in patient safety and
    20         continuous quality improvement every two years.
    21             (ii)  Each nursing home shall ensure that its nursing
    22         home administrator and director of nursing receives at
    23         least six hours of in-person and monitored training in
    24         patient safety and continuous quality improvement every
    25         two years.
    26         (2)  Hospitals and nursing homes currently licensed will
    27     have 12 months following the effective date of this section
    28     to comply with this subsection. Hospitals and nursing homes
    29     applying for a license for the first time following the
    30     effective date of this section shall certify to the
    20070H0700B1011                 - 86 -     

     1     department that the persons described under paragraph (1)
     2     have completed the requisite training within the preceding
     3     12-month period as a condition of being licensed.
     4         (3)  The department shall issue guidelines with respect
     5     to the particular types of patient safety education classes
     6     that will be acceptable. The training shall emphasize the
     7     integrated nature of patient safety and continuous quality
     8     improvement.
     9         (4)  Documentation of training shall be maintained as
    10     part of the records of the hospital or nursing home.
    11         (5)  The training requirements of this subsection are not
    12     to be construed to add to any continuing education
    13     requirements imposed by a State licensing board.
    14         (6)  For the fiscal year 2008-2009 and thereafter, the
    15     State Board of Medicine shall not approve for accreditation
    16     any graduate medical education program in this Commonwealth
    17     that does not require a minimum of six hours of patient
    18     safety training focused on eliminating health-care-acquired
    19     infections, preventing medical errors and integrating safe
    20     practices into the clinical environment.
    21     (i)  Clinical skills assessments.--The State Board of
    22  Medicine may utilize a program similar to the impaired
    23  professional program through which a licensee may be referred
    24  for a clinical skills assessment and undertake a subsequent plan
    25  to improve clinical skills or otherwise address any clinical
    26  skills deficiencies, if the State Board of Medicine has
    27  evaluated the program and approved its use by licensees of the
    28  board. Once approved, the board shall have the authority to
    29  defer disciplinary or corrective action, provided that the
    30  licensee enters into an agreement with the board to undergo the
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     1  assessment and continues to completion with a plan acceptable to
     2  the board to address any deficiency.
     3     (j)  Enforcement.--In addition to any other remedy available,
     4  the council may impose a civil penalty of up to $500 per day for
     5  each failure of a facility to provide the council the
     6  information required under this section. All fines collected
     7  under this subsection shall be deposited in the CAP Fund.
     8  § 7403.  Smoking restrictions.
     9     (a)  Restrictions.--Smoking shall not be permitted and no
    10  individual shall smoke in any of the following indoor areas:
    11         (1)  Places of employment.
    12         (2)  Bars.
    13         (3)  Food service establishments.
    14         (4)  Enclosed indoor areas open to the public.
    15         (5)  Means of mass transportation, including subways,
    16     underground subway stations and, when occupied by passengers,
    17     buses, including school buses, vans, taxicabs and limousines.
    18         (6)  Ticketing, boarding and waiting areas in public
    19     transportation terminals.
    20         (7)  A public or private facility that houses or treats
    21     children and youth, including youth detention centers and
    22     group homes except for facilities in private homes.
    23         (8)  A facility that provides child-care services.
    24     Services provided in a private home are excluded from this
    25     paragraph if children enrolled in the child-care services are
    26     not present.
    27         (9)  Public and private colleges, universities and other
    28     educational and vocational institutions.
    29         (10)  Health care facilities where individuals reside.
    30     This paragraph shall not prohibit smoking by patients in
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     1     separate enclosed rooms of residential health care
     2     facilities, adult care facilities, community mental health
     3     residences or facilities where day treatment programs are
     4     provided, which are designated as smoking rooms for patients
     5     of the facilities or programs and which are ventilated to the
     6     outside.
     7         (11)  Commercial establishments used for the purpose of
     8     carrying on or exercising any trade, profession, vocation or
     9     charitable activity.
    10         (12)  Indoor arenas.
    11         (13)  Zoos.
    12         (14)  Facilities where bingo, as defined in the act of
    13     July 10, 1981 (P.L.214, No.67), known as the Bingo Law, is
    14     played.
    15         (15)  Licensed facilities, as defined under 4 Pa.C.S. §
    16     1103 (relating to definitions), or any other similar type of
    17     facility authorized under State law.
    18     (b)  Signage.--"Smoking" or "No Smoking" signs, or the
    19  international "No Smoking" symbol, which consists of a pictorial
    20  representation of a burning cigarette in a circle with a bar
    21  across it, shall be prominently posted and properly maintained
    22  where smoking is regulated by this section, by the owner,
    23  operator, manager or other person having control of the area.
    24  The owner, operator or manager of a hotel or motel that chooses
    25  to develop and implement a smoking policy for rooms rented to
    26  guests shall post a notice at the reception area of the
    27  establishment as to the availability, upon request, of rooms in
    28  which no smoking is allowed.
    29     (c)  Exceptions.--The provisions of this section shall not
    30  apply to any of the following:
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     1         (1)  Private homes, private residences and private
     2     automobiles.
     3         (2)  A hotel or motel room rented to one or more guests.
     4         (3)  Retail tobacco businesses.
     5         (4)  Cigar bars that, in the calendar year ending
     6     December 31, 2005, generated 10% or more of their total
     7     annual gross income from the onsite sale of tobacco products
     8     and the rental of onsite humidors, not including any sales
     9     from vending machines.
    10     (d)  Relationship to other laws.--Smoking may not be
    11  permitted where prohibited by any other law, rule or regulation
    12  of any Commonwealth agency or any political subdivision. Nothing
    13  in this section shall be construed to restrict the power of any
    14  political subdivision to adopt and enforce additional local
    15  laws, ordinances or regulations which comply with at least the
    16  minimum applicable standards set forth under this section.
    17     (e)  Prohibited acts.--The following shall be unlawful:
    18         (1)  For any person that owns, manages, operates or
    19     otherwise controls the use of an area in which smoking is
    20     prohibited or restricted under this section to fail to comply
    21     with the provisions of this section, except that it shall be
    22     an affirmative defense that during the relevant time period
    23     actual control of the area was not exercised by the person,
    24     but rather by a lessee, a sublessee or another person. To
    25     establish an affirmative defense, the owner, manager,
    26     operator or person who controls the area shall submit an
    27     affidavit and may submit any other relevant proof indicating
    28     that the person did not exercise actual control of the area
    29     during the relevant time period. The affidavit and other
    30     proof shall be sent by certified mail to the appropriate
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     1     enforcement officer within 30 days of receipt by the person
     2     of a notice of violation.
     3         (2)  For an employer whose place of employment is subject
     4     to this section to fail to comply with the provisions of this
     5     section, except that it shall be an affirmative defense that
     6     the employer has made a good faith effort to ensure that
     7     employees comply with the provisions of this section.
     8         (3)  For an individual to smoke in any area where smoking
     9     is prohibited or restricted under this section.
    10     (f)  Penalty for unlawful conduct.--
    11         (1)  If the enforcement officer determines that a
    12     violation of subsection (e) has occurred, the enforcement
    13     officer may impose a civil penalty of not less than $250 for
    14     the first offense, $500 for the second offense and $1,000 for
    15     each subsequent offense. In addition, a court of competent
    16     jurisdiction may order immediate compliance with the
    17     provisions of this section.
    18         (2)  The enforcement officer may bring an action to
    19     recover the civil penalty provided under paragraph (1) in any
    20     court of competent jurisdiction. A civil penalty recovered
    21     under the provisions of this section shall be recovered by
    22     and in the name of the county board of health or the county
    23     for whom the enforcement officer has been designated.
    24     (g)  Enforcement officer.--If a county does not have a board
    25  of health, the governing body of the county shall, by resolution
    26  adopted within 30 days following the effective date of this
    27  section, designate an officer for the purpose of enforcing this
    28  section. The designation shall be filed with the department
    29  within 30 days after adoption and shall be effective 30 days
    30  after it is filed with the department. The enforcement officer
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     1  shall have sole jurisdiction to enforce the provisions of this
     2  section on a countywide basis under the guidelines developed and
     3  published by the department. Any person who desires to register
     4  a complaint under this section may do so with the appropriate
     5  enforcement officer.
     6                             CHAPTER 75
     7                      MISCELLANEOUS PROVISIONS
     8  Sec.
     9  7501.  Regulations.
    10  7502.  Enforcement.
    11  7503.  Severability.
    12  § 7501.  Regulations.
    13     (a)  Regulations promulgated under this part.--Except as
    14  otherwise provided in this part, the promulgation of regulations
    15  under this part by Commonwealth agencies given the authority to
    16  promulgate regulations shall, until three years from the
    17  effective date of this section, be exempt from the following:
    18         (1)  Section 205 of the Commonwealth Documents Law.
    19         (2)  The Commonwealth Attorneys Act.
    20         (3)  The Regulatory Review Act.
    21     (b)  Other regulations.--If, in the determination of the head
    22  of a Commonwealth agency given authority to promulgate
    23  regulations under this part, rulemaking is needed for purposes
    24  of the safety of patients in this Commonwealth, the Commonwealth
    25  agency may promulgate a final-omitted regulation under the
    26  Regulatory Review Act.
    27  § 7502.  Enforcement.
    28     (a)  Determination of violation.--Upon a determination that a
    29  person licensed by the Insurance Department has violated any
    30  provision of this part, the department may, subject to 2 Pa.C.S.
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     1  Chs. 5 Subch. A (relating to practice and procedure of
     2  Commonwealth agencies) and 7 Subch. A (relating to judicial
     3  review of Commonwealth agency action) do any of the following:
     4         (1)  Issue an order requiring the person to cease and
     5     desist from engaging in the violation.
     6         (2)  Suspend or revoke or refuse to issue or renew the
     7     certificate or license of the offending party or parties.
     8         (3)  Impose an administrative penalty of up to $5,000 for
     9     each violation.
    10         (4)  Seek restitution.
    11         (5)  Impose any other penalty or pursue any other remedy
    12     deemed appropriate by the commissioner.
    13     (b)  Other remedies.--The enforcement remedies imposed under
    14  this section are in addition to any other remedies or penalties
    15  which be imposed by any other applicable statute, including the
    16  act of July 22, 1974 (P.L.589, No.205), known as the Unfair
    17  Insurance Practices Act. A violation by any person of this part
    18  is deemed an unfair method of competition and an unfair or
    19  deceptive act of practice under the Unfair Insurance Practices
    20  Act.
    21     (c)  No private cause of action.--Nothing in this part shall
    22  be construed as to create or imply a private cause of action for
    23  violation of this part.
    24  § 7503.  Severability.
    25     (a)  General rule.--The provisions of this part are
    26  severable. If any provision of this part or its application to
    27  any person or circumstance is held invalid, the invalidity shall
    28  not affect other provisions or applications of this part which
    29  can be given effect without the invalid provision or
    30  application.
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     1     (b)  Limitation.--If the provisions of section 7203(b)(2)
     2  (relating to fair share tax) are declared invalid by a court of
     3  competent jurisdiction and the decision is affirmed on its
     4  highest appeal or the appeal period expires without appeal being
     5  filed, the commissioner shall transmit notice of this fact to
     6  the Legislative Reference Bureau for publication as a notice in
     7  the Pennsylvania Bulletin. Thereafter, subsection (c) shall be
     8  effective in its place and stead.
     9     (c)  Alternate provision.--An employer that offers health
    10  care coverage to each of its employees who works 30 hours per
    11  week or more following no more than 90 days of continued
    12  employment during any fiscal year shall be entitled to an annual
    13  credit against the fair share tax in an amount equal to 3% of
    14  the employer's wages for fiscal years 2007-2008 through 2009-
    15  2010 and 3.5% of the employer's wages for fiscal years
    16  commencing after June 30, 2010.
    17     Section 2.  Repeals are as follows:
    18         (1)  The General Assembly declares as follows:
    19             (i)  The repeal under paragraph (2)(vi) is necessary
    20         to effectuate the addition of 40 Pa.C.S. § 7202.
    21             (ii)  The repeal under paragraph (2)(v) is necessary
    22         to effectuate the addition 40 Pa.C.S. § 7204.
    23             (iii)  The repeal under paragraph (2)(iv) is
    24         necessary to effectuate the addition of 40 Pa.C.S. §§
    25         7209 and 7402.
    26             (iv)  The repeals under paragraph (2)(i), (ii) and
    27         (iii) are necessary to effectuate the addition of 40
    28         Pa.C.S. § 7303.
    29         (2)  Subject to section 3 of this act, the following acts
    30     and parts of acts are repealed to the extent specified:
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     1             (i)  The last sentence of section 8.3(b) of the act
     2         of May 22, 1951 (P.L.317, No.69), known as The
     3         Professional Nursing Law, absolutely.
     4             (ii)  Section 8.4 of The Professional Nursing Law,
     5         absolutely.
     6             (iii)  The last sentence of section 13(e) of the act
     7         of December 20, 1985 (P.L.457, No.112), known as the
     8         Medical Practice Act of 1985, absolutely.
     9             (iv)  The first sentence of section 19 of the act of
    10         July 8, 1986 (P.L.408, No.89), known as the Health Care
    11         Cost Containment Act, absolutely.
    12             (v)  Section 3(e)(4) and (5) of the act of December
    13         18, 1996 (P.L.1066, No.159), known as the Accident and
    14         Health Filing Reform Act, absolutely.
    15             (vi)  Chapter 13 of the act of June 26, 2001
    16         (P.L.755, No.77), known as the Tobacco Settlement Act,
    17         absolutely.
    18         (3)  All other acts and parts of acts are repealed
    19     insofar as they are inconsistent with this act.
    20     Section 3.  Savings from repeal are as follows:
    21         (1)  Notwithstanding section 2(2)(iv) of this act, the
    22     Legislative Budget and Finance Committee shall prepare the
    23     report required by section 19 of the act of July 8, 1986
    24     (P.L.408, No.89), known as the Health Care Cost Containment
    25     Act, but the committee need not comment on the
    26     reauthorization of the Health Care Cost Containment Council.
    27         (2)  Notwithstanding section 2(2)(vi) of this act, funds
    28     appropriated under section 306(b)(1)(vi) of the act of June
    29     26, 2001 (P.L.755, No.77), known as the Tobacco Settlement
    30     Act, for the program established in former Chapter 13 of that
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     1     act shall be deposited in the CAP Fund under 40 Pa.C.S. §
     2     7202.
     3     Section 4.  The tax imposed by 40 Pa.C.S. § 7203(a) shall
     4  apply to wages paid by employers commencing with the first full
     5  calendar quarter after the effective date of 40 Pa.C.S. §
     6  7203(a).
     7     Section 5.  This act shall take effect as follows:
     8         (1)  The addition of 40 Pa.C.S. § 7202(a) through (o) and
     9     (q) shall take effect 30 days after publication of the notice
    10     under 40 Pa.C.S. § 7202(p).
    11         (2)  The addition of the following provisions of Title 40
    12     shall take effect in 30 days:
    13             (i)  Section 7203.
    14             (ii)  Section 7205.
    15             (iii)  Section 7303.
    16         (3)  Section 2(2)(vi) of this act shall take effect upon
    17     publication of the notice under 40 Pa.C.S. § 7202(p).
    18         (4)  The remainder of this act shall take effect
    19     immediately.








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