PRINTER'S NO. 3948
No. 2642 Session of 2008
INTRODUCED BY DeLUCA, BIANCUCCI, SHAPIRO, GERBER, MELIO, WALKO,
READSHAW, KOTIK, GRUCELA, SURRA, DePASQUALE, DERMODY, EACHUS,
KORTZ, GERGELY, McILVAINE SMITH, KULA, PALLONE, TANGRETTI,
FREEMAN, PETRONE, DeWEESE, PETRARCA, FABRIZIO, HARKINS AND
VITALI, JUNE 13, 2008
REFERRED TO COMMITTEE ON INSURANCE, JUNE 13, 2008
AN ACT
1 Providing for health insurance rate increase standards.
2 The General Assembly of the Commonwealth of Pennsylvania
3 hereby enacts as follows:
4 Section 1. Short title.
5 This act shall be known and may be cited as the Health
6 Insurance Rate Increase Standards Act.
7 Section 2. Definitions.
8 The following words and phrases when used in this act shall
9 have the meanings given to them in this section unless the
10 context clearly indicates otherwise:
11 "Department." The Insurance Department of the Commonwealth.
12 "Health care-associated infection." A localized or systemic
13 condition that results from an adverse reaction to the presence
14 of an infectious agent or its toxins that:
15 (1) Occurs in a patient in a health care setting.
16 (2) Was not present or incubating at the time of
1 admission, unless the infection was related to a previous
2 admission to the same setting.
3 (3) If occurring in a hospital setting, meets the
4 criteria for a specific infection site as defined by the
5 Centers for Disease Control and Prevention and its National
6 Healthcare Safety Network.
7 "Insurer." A company or health insurance entity licensed in
8 this Commonwealth to issue any individual or group health,
9 sickness or accident policy or subscriber contract or
10 certificate or plan that provides medical or health care
11 coverage by a health care facility or licensed health care
12 provider that is offered or governed under this act or any of
13 the following:
14 (1) The act of December 29, 1972 (P.L.1701, No.364),
15 known as the Health Maintenance Organization Act.
16 (2) The act of May 18, 1976 (P.L.123, No.54), known as
17 the Individual Accident and Sickness Insurance Minimum
18 Standards Act.
19 (3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
20 corporations) or 63 (relating to professional health services
21 plan corporations).
22 "Nurse-managed health clinic." A nurse practice arrangement,
23 managed by advanced practice nurses that provides primary care
24 and is associated with a school, college or department of
25 nursing, federally qualified health center or an independent
26 nonprofit health or social services agency.
27 "Preventable serious adverse event." A clearly defined
28 condition or negative consequence of care that results in
29 unintended injury or illness that could have been anticipated
30 and prepared for, but that occurs because of an error or other
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1 system failure and results in a patient's death, loss of a body
2 part, disability or loss of bodily function lasting more than
3 seven days.
4 Section 3. Health insurance rate increase review.
5 In conjunction with and in addition to the standards set
6 forth under the act of December 18, 1996 (P.L.1066, No.159),
7 known as the Accident and Health Filing Reform Act, and all
8 other applicable statutory and regulatory requirements, the
9 department may disapprove a rate filing based upon the
10 following:
11 (1) The rate is not actuarially sound.
12 (2) The increase is requested because the insurer has
13 not operated efficiently or has factored in experience
14 conflicting with recognized best practices in the health care
15 industry.
16 (3) The increase is requested because the insurer has
17 incurred costs of additional care due to the following:
18 (i) Avoidable health care-associated infections.
19 (ii) Avoidable hospitalizations due to ineffective
20 chronic care management, after data for the incident is
21 available for the department and the insurer to analyze.
22 (iii) Preventable serious adverse events.
23 (iv) The insurer does not reimburse for charges
24 submitted for services provided by a nurse-managed clinic
25 that is credentialed by the Department of Health.
26 Section 4. Effective date.
27 This act shall take effect in 180 days.
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