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                                                      PRINTER'S NO. 1605

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 1192 Session of 2007


        INTRODUCED BY FOLMER, EICHELBERGER, PICCOLA, WAUGH AND BROWNE,
           DECEMBER 3, 2007

        REFERRED TO PUBLIC HEALTH AND WELFARE, DECEMBER 3, 2007

                                     AN ACT

     1  Requiring health care facilities to provide consumers with
     2     certain information about fees; providing for emergency room
     3     patient diversion programs; providing for publication of
     4     information relating to performance of health care
     5     facilities, for electronic health records and for the powers
     6     and duties of the Health Care Cost Containment Council.

     7     The General Assembly of the Commonwealth of Pennsylvania
     8  hereby enacts as follows:
     9  Section 1.  Short title.
    10     This act shall be known and may be cited as the Health Care
    11  Consumer Act.
    12  Section 2.  Definitions.
    13     The following words and phrases when used in this act shall
    14  have the meanings given to them in this section unless the
    15  context clearly indicates otherwise:
    16     "Council."  The Health Care Cost Containment Council.
    17     "Health care facility."  A hospital, outpatient clinic or
    18  nursing home licensed or otherwise regulated by the
    19  Commonwealth.


     1  Section 3.  Publication of fees for services.
     2     (a)  Internet and electronic notice.--A health care facility
     3  shall make available to the public on its Internet website or,
     4  at the request of a resident of this Commonwealth, by other
     5  electronic means or in writing a description of and a link to
     6  the performance outcome and financial data published by the
     7  council under section 5.
     8     (b)  Premises posted notice.--
     9         (1)  A health care facility shall place a notice in its
    10     reception area that the information identified under
    11     subsection (a) is available on its Internet website and, on
    12     request, electronically or in writing from the health care
    13     facility.
    14         (2)  The health care facility may indicate on the notice
    15     that:
    16             (i)  The pricing information is based on a
    17         compilation of charges for the average patient and that
    18         each patient's bill may vary from the average depending
    19         on the severity of the medical condition and resources
    20         used by the patient.
    21             (ii)  The price of service is negotiable for eligible
    22         patients based on their ability to pay.
    23  Section 4.  Emergency room patient diversion programs.
    24     A health care facility that provides emergency medical
    25  services may develop and implement an emergency room patient
    26  diversion program, including, but not limited to:
    27         (1)  An emergency hotline that allows patients to help
    28     determine if emergency medical services are appropriate or if
    29     other health care services may be more appropriate for care.
    30         (2)  A fast track program that allows patients that do
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     1     not require emergency medical services to be treated at an
     2     alternative site, including, but not limited to, a health
     3     care program funded with Federal, State or local funds,
     4     community health center, county health department or other
     5     nonhospital provider of health care services. The program may
     6     include provisions for follow-up care and case management.
     7  Section 5.  Reporting of health care facility charges to
     8                 council.
     9     (a)  General rule.--A health care facility shall submit to
    10  the council data necessary to carry out the council's duties.
    11  Specifications for the data to be submitted under this section
    12  shall be developed by the council with the assistance of
    13  technical advisory panels, including representatives of affected
    14  entities, consumers, purchasers and such other interested
    15  parties as may be determined by the council.
    16     (b)  Data to be submitted.--
    17         (1)  Data submitted by health care facilities include,
    18     but are not limited to: case-mix data, patient admission and
    19     discharge data, hospital emergency department data which
    20     shall include the number of patients treated in the emergency
    21     department of a hospital reported by patient acuity level,
    22     data on hospital-acquired infections, data on complications,
    23     data on readmissions, with patient and provider-specific
    24     identifiers included, actual charge data by diagnostic
    25     groups, financial data, accounting data, operating expenses,
    26     expenses incurred for rendering services to patients who
    27     cannot or do not pay, interest charges, depreciation expenses
    28     based on the expected useful life of the property and
    29     equipment involved and demographic data.
    30         (2)  The council shall adopt nationally recognized risk
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     1     adjustment methodologies or software consistent with the
     2     standards of the Agency for Healthcare Research and Quality
     3     and as selected by the council for all data submitted as
     4     required by this section. Data may be obtained from documents
     5     such as, but not limited to, leases, contracts, debt
     6     instruments, itemized patient bills, medical record abstracts
     7     and related diagnostic information. Reported data elements
     8     shall be reported electronically. Data submitted shall be
     9     certified by the chief executive officer or an appropriate
    10     and duly authorized representative or employee of the health
    11     care facility that the information submitted is true and
    12     accurate.
    13     (c)  Limitation.--Data required to be submitted by health
    14  care facilities shall not include specific provider contract
    15  reimbursement information. However, such specific provider
    16  reimbursement data shall be reasonably available for onsite
    17  inspection by the council as is necessary to carry out the
    18  council's duties. Any such data obtained by the council as a
    19  result of onsite inspections may not be used by the Commonwealth
    20  for purposes of direct provider contracting and are
    21  confidential.
    22  Section 6.  Publication of comprehensive health information.
    23     In order to produce comparable and uniform health information
    24  and statistics, the council shall develop and implement a long-
    25  range plan for making available performance outcome and
    26  financial data of health care facilities that will allow
    27  consumers to compare health care services. The council shall
    28  also make the plan and status report available to the public on
    29  its Internet website. As part of the plan, the council shall
    30  identify the process and timeframes for implementation, any
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     1  barriers to implementation and recommendations of changes in the
     2  law that may be enacted by the General Assembly to eliminate the
     3  barriers. As preliminary elements of the plan, the council
     4  shall:
     5         (1)  Make available performance outcome and patient
     6     charge data collected from health care facilities under
     7     section 5. The council shall determine which conditions and
     8     procedures, performance outcomes and patient charge data to
     9     disclose. When determining which conditions and procedures
    10     are to be disclosed, the council shall consider variation in
    11     costs, variation in outcomes, magnitude of variations and
    12     other relevant information. When determining which
    13     performance outcomes to disclose, the council:
    14             (i)  Shall consider such factors as volume of cases,
    15         average patient charges, average length of stay,
    16         complication rates, mortality rates and infection rates,
    17         among others, which shall be adjusted for case mix and
    18         severity, if applicable.
    19             (ii)  May consider such additional measures that are
    20         adopted by the Centers for Medicare and Medicaid Studies,
    21         National Quality Forum, the Joint Commission on
    22         Accreditation of Healthcare Organizations, the Agency for
    23         Healthcare Research and Quality or a similar national
    24         entity that establishes standards to measure the
    25         performance of health care providers, or by other states.
    26     When determining which patient charge data to disclose, the
    27     council shall consider such measures as average charge,
    28     average net revenue per adjusted patient day, average cost
    29     per adjusted patient day and average cost per admission,
    30     among others.
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     1         (2)  Determine the method and format for public
     2     disclosure of data reported pursuant to this act. At a
     3     minimum, the data shall be made available on the council's
     4     Internet website in a manner that allows consumers to conduct
     5     an interactive search that allows them to view and compare
     6     the information for specific providers. The Internet website
     7     must include such additional information as is determined
     8     necessary to ensure that the Internet website enhances
     9     informed decision making among consumers and health care
    10     purchasers, which shall include, at a minimum, appropriate
    11     guidance on how to use the data and an explanation of why the
    12     data may vary from provider to provider. The data shall be
    13     released no later than      .
    14  Section 7.  Electronic health records.
    15     (a)  Strategy to be developed by council.--The council shall
    16  develop and implement a strategy for health care facilities to
    17  adopt and use electronic health records of patients. The council
    18  may develop rules to facilitate the functionality and protect
    19  the confidentiality of electronic health records of patients.
    20     (b)  Report to Governor and General Assembly.--The council
    21  shall report to the Governor, the President pro tempore of the
    22  Senate and the Speaker of the House of Representatives on any
    23  legislation necessary to protect the confidentiality of
    24  electronic health records.
    25  Section 8.  Effective date.
    26     This act shall take effect in 60 days.



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