PRINTER'S NO. 1942
No. 1356 Session of 2008
INTRODUCED BY COSTA, HUGHES, FONTANA, STOUT, WASHINGTON,
KASUNIC, MUSTO, STACK, O'PAKE, KITCHEN, C. WILLIAMS AND FUMO,
APRIL 9, 2008
REFERRED TO BANKING AND INSURANCE, APRIL 9, 2008
AN ACT
1 Amending the act of March 20, 2002 (P.L.154, No.13), entitled
2 "An act reforming the law on medical professional liability;
3 providing for patient safety and reporting; establishing the
4 Patient Safety Authority and the Patient Safety Trust Fund;
5 abrogating regulations; providing for medical professional
6 liability informed consent, damages, expert qualifications,
7 limitations of actions and medical records; establishing the
8 Interbranch Commission on Venue; providing for medical
9 professional liability insurance; establishing the Medical
10 Care Availability and Reduction of Error Fund; providing for
11 medical professional liability claims; establishing the Joint
12 Underwriting Association; regulating medical professional
13 liability insurance; providing for medical licensure
14 regulation; providing for administration; imposing penalties;
15 and making repeals," further providing for medical
16 professional liability insurance, for the Medical Care
17 Availability and Reduction of Error Fund and for actuarial
18 data; establishing the Continuing Access with Relief for
19 Employers (CARE) Fund; further defining "health care
20 provider"; further providing for the Health Care Provider
21 Retention Program; establishing the Supplemental Assistance
22 and Funding Account; further providing for expiration of the
23 Health Care Provider Retention Program; and providing for
24 Continuing Access with Relief for Employers (CARE) Grants.
25 The General Assembly of the Commonwealth of Pennsylvania
26 hereby enacts as follows:
27 Section 1. Section 711(d) and (g) of the act of March 20,
28 2002 (P.L.154, No.13), known as the Medical Care Availability
1 and Reduction of Error (Mcare) Act, are amended to read:
2 Section 711. Medical professional liability insurance.
3 * * *
4 (d) Basic coverage limits.--A health care provider shall
5 insure or self-insure medical professional liability in
6 accordance with the following:
7 (1) For policies issued or renewed in the calendar year
8 2002, the basic insurance coverage shall be:
9 (i) $500,000 per occurrence or claim and $1,500,000
10 per annual aggregate for a health care provider who
11 conducts more than 50% of its health care business or
12 practice within this Commonwealth and that is not a
13 hospital.
14 (ii) $500,000 per occurrence or claim and $1,500,000
15 per annual aggregate for a health care provider who
16 conducts 50% or less of its health care business or
17 practice within this Commonwealth.
18 (iii) $500,000 per occurrence or claim and
19 $2,500,000 per annual aggregate for a hospital.
20 (2) For policies issued or renewed in the calendar years
21 2003[, 2004 and 2005] through 2008, the basic insurance
22 coverage shall be:
23 (i) $500,000 per occurrence or claim and $1,500,000
24 per annual aggregate for a participating health care
25 provider that is not a hospital.
26 (ii) $1,000,000 per occurrence or claim and
27 $3,000,000 per annual aggregate for a nonparticipating
28 health care provider.
29 (iii) $500,000 per occurrence or claim and
30 $2,500,000 per annual aggregate for a hospital.
20080S1356B1942 - 2 -
1 [(3) Unless the commissioner finds pursuant to section
2 745(a) that additional basic insurance coverage capacity is
3 not available, for policies issued or renewed in calendar
4 year 2006 and each year thereafter subject to paragraph (4),
5 the basic insurance coverage shall be:
6 (i) $750,000 per occurrence or claim and $2,250,000
7 per annual aggregate for a participating health care
8 provider that is not a hospital.
9 (ii) $1,000,000 per occurrence or claim and
10 $3,000,000 per annual aggregate for a nonparticipating
11 health care provider.
12 (iii) $750,000 per occurrence or claim and
13 $3,750,000 per annual aggregate for a hospital.
14 If the commissioner finds pursuant to section 745(a) that
15 additional basic insurance coverage capacity is not
16 available, the basic insurance coverage requirements shall
17 remain at the level required by paragraph (2); and the
18 commissioner shall conduct a study every two years until the
19 commissioner finds that additional basic insurance coverage
20 capacity is available, at which time the commissioner shall
21 increase the required basic insurance coverage in accordance
22 with this paragraph.
23 (4) Unless the commissioner finds pursuant to section
24 745(b) that additional basic insurance coverage capacity is
25 not available, for policies issued or renewed three years
26 after the increase in coverage limits required by paragraph
27 (3) and for each year thereafter, the basic insurance
28 coverage shall be:
29 (i) $1,000,000 per occurrence or claim and
30 $3,000,000 per annual aggregate for a participating
20080S1356B1942 - 3 -
1 health care provider that is not a hospital.
2 (ii) $1,000,000 per occurrence or claim and
3 $3,000,000 per annual aggregate for a nonparticipating
4 health care provider.
5 (iii) $1,000,000 per occurrence or claim and
6 $4,500,000 per annual aggregate for a hospital.
7 If the commissioner finds pursuant to section 745(b) that
8 additional basic insurance coverage capacity is not
9 available, the basic insurance coverage requirements shall
10 remain at the level required by paragraph (3); and the
11 commissioner shall conduct a study every two years until the
12 commissioner finds that additional basic insurance coverage
13 capacity is available, at which time the commissioner shall
14 increase the required basic insurance coverage in accordance
15 with this paragraph.]
16 (5) For policies issued or renewed in calendar year
17 2009, the basic insurance coverage shall be:
18 (i) $550,000 per occurrence or claim and $1,650,000
19 per annual aggregate for a participating health care
20 provider that is not a hospital.
21 (ii) $1,000,000 per occurrence or claim and
22 $3,000,000 per annual aggregate for a nonparticipating
23 health care provider.
24 (iii) $550,000 per occurrence or claim and
25 $2,700,000 per annual aggregate for a hospital.
26 (6) For policies issued or renewed in calendar years
27 2010 and thereafter:
28 (i) The basic insurance coverage for a participating
29 health care provider that is not a hospital shall
30 increase by $50,000 per occurrence or claim and $150,000
20080S1356B1942 - 4 -
1 per annual aggregate per year until such time as the
2 basic insurance coverage required shall be $1,000,000 per
3 occurrence or claim and $3,000,000 per annual aggregate.
4 (ii) The basic insurance coverage for a
5 nonparticipating health care provider shall be $1,000,000
6 per occurrence or claim and $3,000,000 per annual
7 aggregate.
8 (iii) The basic insurance coverage for a hospital
9 shall increase by $50,000 per occurrence or claim and
10 $200,000 per annual aggregate until such time as the
11 basic insurance coverage requirement shall be $1,000,000
12 per occurrence or claim and $4,500,000 per annual
13 aggregate per year.
14 (7) Basic insurance coverage amounts shall be exclusive
15 of a deductible or any other contribution from the health
16 care provider.
17 * * *
18 (g) Basic insurance liability.--
19 (1) An insurer providing medical professional liability
20 insurance shall not be liable for payment of a claim against
21 a health care provider for any loss or damages awarded in a
22 medical professional liability action in excess of the basic
23 insurance coverage required by subsection (d) unless the
24 health care provider's medical professional liability
25 insurance policy or self-insurance plan provides for a higher
26 limit.
27 (2) If a claim exceeds the limits of a participating
28 health care provider's basic insurance coverage or self-
29 insurance plan, the fund shall be responsible for payment of
30 the claim against the participating health care provider up
20080S1356B1942 - 5 -
1 to the fund liability limits. The fund shall not be
2 responsible if a claimant has waived collection of any
3 portion of the applicable basic insurance coverage limit.
4 (3) If the health care provider has more than one basic
5 insurance coverage policy with more than one insurer
6 applicable to a claim, the fund shall be liable when the
7 policy with the highest limit has been tendered to the fund.
8 * * *
9 Section 2. Section 712(c), (d), (e), (i), (j) and (m) of the
10 act are amended and the section is amended by adding a
11 subsection to read:
12 Section 712. Medical Care Availability and Reduction of Error
13 Fund.
14 * * *
15 (c) Fund liability limits.--
16 (1) For calendar year 2002, the limit of liability of
17 the fund created in section 701(d) of the former Health Care
18 Services Malpractice Act for each health care provider that
19 conducts more than 50% of its health care business or
20 practice within this Commonwealth and for each hospital shall
21 be $700,000 for each occurrence and $2,100,000 per annual
22 aggregate.
23 (2) The limit of liability of the fund for each
24 participating health care provider shall be [as follows:
25 (i) For] for calendar year 2003 and each year
26 thereafter, the limit of liability of the fund shall be
27 $500,000 for each occurrence and $1,500,000 per annual
28 aggregate.
29 [(ii) If the basic insurance coverage requirement is
30 increased in accordance with section 711(d)(3) and,
20080S1356B1942 - 6 -
1 notwithstanding subparagraph (i), for each calendar year
2 following the increase in the basic insurance coverage
3 requirement, the limit of liability of the fund shall be
4 $250,000 for each occurrence and $750,000 per annual
5 aggregate.
6 (iii) If the basic insurance coverage requirement is
7 increased in accordance with section 711(d)(4) and,
8 notwithstanding subparagraphs (i) and (ii), for each
9 calendar year following the increase in the basic
10 insurance coverage requirement, the limit of liability of
11 the fund shall be zero.]
12 (3) The limit of liability of the fund for each
13 participating health care provider shall be:
14 (i) For calendar years 2003 through 2008, $500,000
15 for each occurrence and $1,500,000 per annual aggregate.
16 (ii) For calendar year 2009, $450,000 per occurrence
17 or claim and $1,350,000 per annual aggregate.
18 (iii) For calendar years 2010 and thereafter, the
19 limit of liability shall decrease by $50,000 per
20 occurrence or claim and $150,000 per annual aggregate per
21 year until such time as the fund limit of liability shall
22 be zero dollars per occurrence or claim and zero dollars
23 per annual aggregate.
24 (d) Assessments.--
25 (1) For calendar [year 2003 and for each year
26 thereafter,] years 2003 through 2017, the fund shall be
27 funded by an assessment on each participating health care
28 provider. Assessments shall be levied by the department on or
29 after January 1 of each year. The assessment shall be based
30 on the prevailing primary premium for each participating
20080S1356B1942 - 7 -
1 health care provider and shall, in the aggregate, produce an
2 amount sufficient to do all of the following:
3 (i) Reimburse the fund for the payment of reported
4 claims which became final during the preceding claims
5 period.
6 (ii) Pay expenses of the fund incurred during the
7 preceding claims period.
8 (iii) Pay principal and interest on moneys
9 transferred into the fund in accordance with section
10 713(c).
11 (iv) Provide a reserve that shall be 10% of the sum
12 of subparagraphs (i), (ii) and (iii).
13 (2) The department shall notify all basic insurance
14 coverage insurers and self-insured participating health care
15 providers of the assessment by November 1 for the succeeding
16 calendar year.
17 (3) Any appeal of the assessment shall be filed with the
18 department.
19 [(e) Discount on surcharges and assessments.--
20 (1) For calendar year 2002, the department shall
21 discount the aggregate surcharge imposed under section
22 701(e)(1) of the Health Care Services Malpractice Act by 5%
23 of the aggregate surcharge imposed under that section for
24 calendar year 2001 in accordance with the following:
25 (i) Fifty percent of the aggregate discount shall be
26 granted equally to hospitals and to participating health
27 care providers that were surcharged as members of one of
28 the four highest rate classes of the prevailing primary
29 premium.
30 (ii) Notwithstanding subparagraph (i), 50% of the
20080S1356B1942 - 8 -
1 aggregate discount shall be granted equally to all
2 participating health care providers.
3 (iii) The department shall issue a credit to a
4 participating health care provider who, prior to the
5 effective date of this section, has paid the surcharge
6 imposed under section 701(e)(1) of the former Health Care
7 Services Malpractice Act for calendar year 2002 prior to
8 the effective date of this section.
9 (2) For calendar years 2003 and 2004, the department
10 shall discount the aggregate assessment imposed under
11 subsection (d) for each calendar year by 10% of the aggregate
12 surcharge imposed under section 701(e)(1) of the former
13 Health Care Services Malpractice Act for calendar year 2001
14 in accordance with the following:
15 (i) Fifty percent of the aggregate discount shall be
16 granted equally to hospitals and to participating health
17 care providers that were assessed as members of one of
18 the four highest rate classes of the prevailing primary
19 premium.
20 (ii) Notwithstanding subparagraph (i), 50% of the
21 aggregate discount shall be granted equally to all
22 participating health care providers.
23 (3) For calendar years 2005 and thereafter, if the basic
24 insurance coverage requirement is increased in accordance
25 with section 711(d)(3) or (4), the department may discount
26 the aggregate assessment imposed under subsection (d) by an
27 amount not to exceed the aggregate sum to be deposited in the
28 fund in accordance with subsection (m).]
29 * * *
30 (i) Change in basic insurance coverage.--If a participating
20080S1356B1942 - 9 -
1 health care provider changes the term of its medical
2 professional liability insurance coverage, the assessment shall
3 be calculated on an annual basis and shall reflect the
4 assessment percentages in effect for the period over which the
5 policies are in effect. A policy period less than 12 months may
6 result in a prorated reduction in the Mcare annual aggregate
7 limit.
8 (j) Payment of claims.--Claims which became final during the
9 preceding claims period shall be paid on [or before] December 31
10 or the last business day of the year following the August 31 on
11 which they became final.
12 * * *
13 (m) Supplemental funding.--Notwithstanding the provisions of
14 75 Pa.C.S. § 6506(b) (relating to surcharge) to the contrary,
15 beginning January 1, 2004, [and for a period of nine calendar
16 years thereafter,] through June 30, 2018, all surcharges levied
17 and collected under 75 Pa.C.S. § 6506(a) by any division of the
18 unified judicial system shall be remitted to the Commonwealth
19 for deposit in the Medical Care Availability and [Restriction]
20 Reduction of Error Fund. These funds shall be used to reduce
21 surcharges and assessments in accordance with subsection (e).
22 Beginning [January 1, 2014] July 1, 2018, and each year
23 thereafter, the surcharges levied and collected under 75 Pa.C.S.
24 § 6506(a) shall be deposited into the [General Fund.] Health
25 Care Provider Retention Account.
26 * * *
27 (o) Coverage of claims in relation to payment of certain
28 late assessments.--
29 (1) All basic insurance coverage insurers, self-insured
30 participating health care providers and risk retention groups
20080S1356B1942 - 10 -
1 shall bill, collect and remit the assessment to the
2 department within 60 days of the inception or renewal date of
3 the primary professional liability policy.
4 (2) All basic insurance coverage insurers, self-insured
5 participating health care providers and risk retention groups
6 shall be subject to the following:
7 (i) For assessments remitted to the department in
8 excess of 60 days after the inception or renewal date of
9 the primary policy, the basic insurance coverage insurer,
10 self-insured participating health care provider or risk
11 retention group shall pay to the department a penalty
12 equal to 10% per annum of each untimely assessment
13 accruing from the 61st day after the inception or renewal
14 date of the primary policy until the remittance is
15 received by the department.
16 (ii) In addition to the provisions of subparagraph
17 (i), if the department finds that there has been a
18 pattern or practice of not complying with this section,
19 the basic insurance coverage insurer, self-insured
20 participating health care provider or risk retention
21 group shall be subject to the penalties and process set
22 forth in the act of July 22, 1974 (P.L.589, No.205),
23 known as the Unfair Insurance Practices Act.
24 (iii) If the basic insurance coverage insurer, self-
25 insurer or risk retention group receives the assessment
26 from a health care provider, professional corporation or
27 professional association with less than 30 days to make
28 the remittance timely as provided under this subsection,
29 the basic insurance coverage insurer, self-insurer or
30 risk retention group remittance period shall be extended
20080S1356B1942 - 11 -
1 by 30 days from the date of receipt upon providing
2 reasonable evidence to the department regarding the date
3 of receipt and shall not be subject to the penalties
4 provided for under this section.
5 (iv) If the basic insurance coverage insurer, self-
6 insurer or risk retention group receives an assessment
7 after 60 days of the inception or renewal date of the
8 primary professional liability policy and remits the
9 assessment within 30 days from the date of receipt, the
10 basic insurance coverage insurer, self-insurer or risk
11 retention group shall not be subject to the penalties
12 provided for under this section. Remittances to the
13 department beyond the 30-day period shall be subject to
14 the penalties provided for under this section.
15 (v) (A) A health care provider or professional
16 corporation, professional association or partnership
17 shall be provided coverage from the inception or
18 renewal date of the primary professional liability
19 policy if the billed assessment is paid to the basic
20 insurance coverage insurer, self-insurer or risk
21 retention group within 60 days of the inception or
22 renewal date of the primary professional liability
23 policy.
24 (B) A health care provider or professional
25 corporation, professional association or partnership
26 that fails to pay the billed assessment to its basic
27 insurance coverage insurer, self-insurer or risk
28 retention group within 60 days of policy inception or
29 renewal and before receiving notice of a claim shall
30 not have coverage for that claim.
20080S1356B1942 - 12 -
1 (C) If a health care provider or professional
2 corporation, professional association or partnership
3 is billed by the basic insurance coverage insurer,
4 self-insurer or risk retention group later than 30
5 days after the policy inception or renewal date and
6 the health care provider or professional corporation,
7 professional association or partnership pays the
8 basic insurance coverage insurer, self-insurer or
9 risk retention group within 30 days from the date of
10 receipt of the bill and the basic insurance coverage
11 insurer, self-insurer or risk retention group carrier
12 remits the assessment to the department within 30
13 days from the date of receipt, the health care
14 provider shall be provided coverage as of the
15 inception or renewal date of the primary policy.
16 Coverage shall also be provided to the health care
17 provider or professional corporation, professional
18 association or partnership for all professional
19 liability claims made after payment of the
20 assessment.
21 (vi) Except as to provisions in conflict with this
22 section, nothing in this section shall be construed to
23 affect existing regulations saved by section 5107(a), and
24 all existing regulations shall remain in full force and
25 effect.
26 Section 3. Section 745 of the act is repealed:
27 [Section 745. Actuarial data.
28 (a) Initial study.--The following shall apply:
29 (1) No later than April 1, 2005, each insurer providing
30 medical professional liability insurance in this Commonwealth
20080S1356B1942 - 13 -
1 shall file loss data as required by the commissioner. For
2 failure to comply, the commissioner shall impose an
3 administrative penalty of $1,000 for every day that this data
4 is not provided in accordance with this paragraph.
5 (2) By July 1, 2005, the commissioner shall conduct a
6 study regarding the availability of additional basic
7 insurance coverage capacity. The study shall include an
8 estimate of the total change in medical professional
9 liability insurance loss-cost resulting from implementation
10 of this act prepared by an independent actuary. The fee for
11 the independent actuary shall be borne by the fund. In
12 developing the estimate, the independent actuary shall
13 consider all of the following:
14 (i) The most recent accident year and ratemaking
15 data available.
16 (ii) Any other relevant factors within or outside
17 this Commonwealth in accordance with sound actuarial
18 principles.
19 (b) Additional study.--The following shall apply:
20 (1) Three years following the increase of the basic
21 insurance coverage requirement in accordance with section
22 711(d)(3), each insurer providing medical professional
23 liability insurance in this Commonwealth shall file loss data
24 with the commissioner upon request. For failure to comply,
25 the commissioner shall impose an administrative penalty of
26 $1,000 for every day that this data is not provided in
27 accordance with this paragraph.
28 (2) Three months following the request made under
29 paragraph (1), the commissioner shall conduct a study
30 regarding the availability of additional basic insurance
20080S1356B1942 - 14 -
1 coverage capacity. The study shall include an estimate of the
2 total change in medical professional liability insurance
3 loss-cost resulting from implementation of this act prepared
4 by an independent actuary. The fee for the independent
5 actuary shall be borne by the fund. In developing the
6 estimate, the independent actuary shall consider all of the
7 following:
8 (i) The most recent accident year and ratemaking
9 data available.
10 (ii) Any other relevant factors within or outside
11 this Commonwealth in accordance with sound actuarial
12 principles.]
13 Section 4. Chapter 7 of the act is amended by adding
14 subchapters to read:
15 SUBCHAPTER E
16 (RESERVED)
17 SUBCHAPTER F
18 CONTINUING ACCESS WITH RELIEF FOR
19 EMPLOYERS (CARE) FUND
20 Section 761. Establishment.
21 There is established within the State Treasury a special fund
22 to be known as the Continuing Access with Relief for Employers
23 (CARE) Fund.
24 Section 762. Allocation.
25 Money in the Continuing Access with Relief for Employers
26 (CARE) Fund is hereby appropriated on a continuing basis to the
27 Department of Community and Economic Development and shall be
28 dedicated to assisting certain employers that currently offer
29 and maintain health care coverage for their employees in
30 compliance with the requirements under section 1308.
20080S1356B1942 - 15 -
1 Section 5. The definition of "health care provider" in
2 section 1101 of the act, added December 22, 2005 (P.L.458,
3 No.88), is amended to read:
4 Section 1101. 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 * * *
9 "Health care provider." [An individual who is all of the
10 following:
11 (1) A physician, licensed podiatrist, certified nurse
12 midwife or nursing home.
13 (2) A participating health care provider as defined in
14 section 702.] Any of the following:
15 (1) A nursing home or birth center that is a
16 participating health care provider as defined in section 702.
17 (2) An individual who is a physician, licensed
18 podiatrist or certified nurse midwife.
19 * * *
20 Section 6. Section 1102 of the act, amended October 27, 2006
21 (P.L.1198, No.128), is amended to read:
22 Section 1102. Abatement program.
23 (a) Establishment.--There is hereby established within the
24 Insurance Department a program to be known as the Health Care
25 Provider Retention Program. The Insurance Department, in
26 conjunction with the Department of Public Welfare, shall
27 administer the program. The program shall provide assistance in
28 the form of assessment abatements to health care providers for
29 calendar years [2003, 2004, 2005, 2006 and 2007] beginning 2003
30 and ending 2017, except that licensed podiatrists shall not be
20080S1356B1942 - 16 -
1 eligible for calendar years 2003 and 2004, and nursing homes
2 shall not be eligible for calendar years 2003, 2004 and 2005.
3 (b) Other [abatement.--] abatements.--
4 (1) Emergency physicians not employed full time by a
5 trauma center or working under an exclusive contract with a
6 trauma center shall retain eligibility for an abatement
7 pursuant to section 1104(b)(2) for calendar years 2003, 2004,
8 2005 and 2006. Commencing in calendar year 2007, these
9 emergency physicians shall be eligible for an abatement
10 pursuant to section 1104(b)(1).
11 (2) Birth centers shall retain eligibility for abatement
12 pursuant to section 1104(b)(2) for calendar years 2003, 2004,
13 2005, 2006 and 2007. Commencing in calendar year 2008, birth
14 centers shall be eligible for abatement pursuant to section
15 1104(b)(1).
16 Section 7. Section 1103 of the act, added December 22, 2005
17 (P.L.458, No.88), is amended by adding paragraphs to read:
18 Section 1103. Eligibility.
19 A health care provider shall not be eligible for [assessment]
20 abatement under the program if any of the following apply:
21 * * *
22 (6) The health care provider has refused to be an active
23 provider in the Pennsylvania Access to Basic Care (PA ABC)
24 Program in the health care provider's service area.
25 (7) The active health care provider is an active
26 provider in the Pennsylvania Access to Basic Care (PA ABC)
27 Program and places restrictions on benefits for patients
28 enrolled in that program.
29 (8) The health care provider has refused to be an active
30 provider in the children's health insurance program
20080S1356B1942 - 17 -
1 established under Article XXIII of the act of May 17, 1921
2 (P.L.682, No.284), known as The Insurance Company Law of
3 1921.
4 (9) The active health care provider is an active
5 provider in the children's health insurance program and
6 places restrictions on benefits for patients enrolled in the
7 children's health insurance program.
8 (10) The Department of Revenue has determined that the
9 health care provider has not filed all required State tax
10 reports and returns for all applicable taxable years or has
11 not paid any balance of State tax due as determined at
12 settlement, assessment or determination by the Department of
13 Revenue that are not subject to a timely perfected
14 administrative or judicial appeal or subject to a duly
15 authorized deferred payment plan as of the date of
16 application. Notwithstanding the provisions of section 353(f)
17 of the act of March 4, 1971 (P.L.6, No.2), known as the Tax
18 Reform Code of 1971, the Department of Revenue shall supply
19 the Insurance Department with information concerning the
20 status of delinquent taxes owed by a health care provider for
21 purposes of this paragraph.
22 (11) (i) The health care provider has not attended at
23 least one Commonwealth-sponsored independent drug
24 information service session, either in person or by
25 videoconference.
26 (ii) This paragraph does not apply if the
27 Commonwealth has not made a Commonwealth-sponsored
28 independent drug information service session available to
29 the health care provider prior to the date that the
30 health care provider's application is submitted under
20080S1356B1942 - 18 -
1 section 1104.
2 Section 8. Section 1104(b) of the act, added December 22,
3 2005 (P.L.458, No.88), is amended to read:
4 Section 1104. Procedure.
5 * * *
6 (b) Review.--Upon receipt of a completed application, the
7 Insurance Department shall review the applicant's information
8 and grant the applicable abatement of the assessment for the
9 previous calendar year specified on the application in
10 accordance with all of the following:
11 (1) The Insurance Department shall notify the Department
12 of Public Welfare that the applicant has self-certified as
13 eligible and was not disqualified for an abatement under
14 section 1103(6), (7), (8), (9), (10) and (11) for a 100%
15 abatement of the imposed assessment if the health care
16 provider was assessed under section 712(d) as:
17 (i) a physician who is assessed as a member of one
18 of the four highest rate classes of the prevailing
19 primary premium;
20 (ii) an emergency physician;
21 (iii) a physician who routinely provides obstetrical
22 services in rural areas as designated by the Insurance
23 Department; [or]
24 (iv) a certified nurse midwife[.]; or
25 (v) a birth center.
26 (2) The Insurance Department shall notify the Department
27 of Public Welfare that the applicant has self-certified as
28 eligible and was not disqualified for an abatement under
29 section 1103(6), (7), (8), (9), (10) and (11) for a 50%
30 abatement of the imposed assessment in calendar years 2008
20080S1356B1942 - 19 -
1 through 2012, a 56.5% abatement in calendar year 2013, a
2 63.5% abatement in calendar year 2014, a 70% abatement in
3 calendar year 2015, a 78% abatement in calendar year 2016, an
4 88% abatement in calendar year 2017 and a 100% abatement in
5 calendar year 2018 if the health care provider was assessed
6 under section 712(d) as:
7 (i) a physician but is a physician who does not
8 qualify for abatement under paragraph (1);
9 (ii) a licensed podiatrist; [or]
10 (iii) a nursing home[.]; or
11 (iv) a birth center.
12 * * *
13 Section 9. Section 1112(c) and (e) of the act, added
14 December 22, 2005 (P.L.458, No.88), are amended and the section
15 is amended by adding subsections to read:
16 Section 1112. Health Care Provider Retention Account.
17 * * *
18 (a.1) Supplemental Assistance and Funding Account.--There is
19 established within the Health Care Provider Retention Account a
20 special account to be known as the Supplemental Assistance and
21 Funding Account. Funds in this account shall be used annually to
22 supplement the funding of the Pennsylvania Access to Basic Care
23 (PA ABC) Program.
24 * * *
25 (c) Transfers from account.--
26 (1) The Secretary of the Budget may annually transfer
27 from the account to the Medical Care Availability and
28 Reduction of Error (Mcare) Fund an amount up to the aggregate
29 amount of abatements granted by the Insurance Department
30 under section 1104(b).
20080S1356B1942 - 20 -
1 (2) In addition to the transfers specified in paragraph
2 (1), the Secretary of the Budget may also transfer funds from
3 the account to the Medical Care Availability and Reduction of
4 Error (Mcare) Fund for the purpose of paying claims and
5 operating expenses coming due after January 1, 2018.
6 (3) The Secretary of the Budget may transfer funds from
7 the account to the Pennsylvania Access to Basic Care (PA ABC)
8 Program Fund.
9 (4) The Secretary of the Budget shall annually transfer
10 from the account to the Continuing Access Relief for
11 Employers (CARE) Fund an amount at least equal to the amount
12 deposited under section 712(m).
13 (c.1) Transfers from the Supplemental Assistance and Funding
14 Account.--The Secretary of the Budget shall annually transfer
15 funds from the Supplemental Assistance and Funding Account
16 established under subsection (a.1) to the Pennsylvania Access to
17 Basic Care (PA ABC) Program Fund.
18 * * *
19 [(e) Administration assistance.--The Insurance Department
20 shall provide assistance to the Department of Public Welfare in
21 administering the account.]
22 Section 10. Section 1115 of the act, amended October 27,
23 2006 (P.L.1198, No.128), is amended to read:
24 Section 1115. Expiration.
25 The Health Care Provider Retention Program established under
26 this chapter shall expire December 31, [2008] 2018.
27 Section 11. The act is amended by adding a chapter to read:
28 CHAPTER 13
29 RESERVED
30 Section 1301. (Reserved).
20080S1356B1942 - 21 -
1 Section 1302. (Reserved).
2 Section 1303. (Reserved).
3 Section 1304. (Reserved).
4 Section 1305. (Reserved).
5 Section 1306. (Reserved).
6 Section 1307. (Reserved).
7 Section 1308. Continuing Access with Relief for Employers
8 (CARE) grants.
9 (a) General rule.--A Continuing Access with Relief for
10 Employers (CARE) grant shall be provided to employers that meet
11 the requirements of this section.
12 (b) Eligibility.--An employer is eligible to receive a CARE
13 grant if that employer meets the following:
14 (1) has maintained coverage for at least 12 consecutive
15 months prior to the effective date of this act; or
16 (2) (i) has maintained coverage for at least 12
17 consecutive months prior to applying for the CARE grant;
18 (ii) has incurred a health care expense in this
19 Commonwealth; and
20 (iii) has a tax liability for the year in which
21 application is made for the CARE grant.
22 (c) Application.--Beginning July 1, 2009, and for each year
23 thereafter, an employer seeking to receive a CARE grant shall
24 submit an application to the department containing, at a
25 minimum, the following information:
26 (1) A statement of the aggregate health care expense
27 made by the employer to provide coverage during the previous
28 12 consecutive months to employees.
29 (2) The names, addresses and Social Security numbers of
30 the employees provided health care coverage under paragraph
20080S1356B1942 - 22 -
1 (1) and whether that health care coverage is for the employee
2 or the employee and the employee's spouse and/or dependents.
3 (3) The names and addresses of the insurance carriers or
4 underwriters that received payment from the employer for the
5 health care coverage provided under paragraph (2).
6 (d) Computation.--An employer who qualifies under subsection
7 (b) shall receive a grant limited to actual employer health care
8 expenses paid for the previous 12 consecutive months in
9 accordance with the following:
10 (1) No greater than 25% of the employer's health care
11 expense to maintain health care coverage for the employee.
12 (2) No greater than 50% of the employer's health care
13 expense to maintain health care coverage for the employee,
14 the employee's spouse and/or dependents.
15 (3) The total amount of paragraphs (1) and (2) shall not
16 exceed the tax liability owed by the employer for the year
17 application is made for the CARE grant.
18 (4) If no tax liability is owed by the employer then the
19 employer may not apply for a CARE grant.
20 (e) Duties of department.--The department has the following
21 duties:
22 (1) Administer the program.
23 (2) In consultation with other appropriate Commonwealth
24 agencies:
25 (i) Develop an application for the collection of
26 information that is consistent with the requirements of
27 this section and that contains any other information that
28 may be necessary to award CARE grants.
29 (ii) Develop a process to determine the validity of
30 information collected by the department from the
20080S1356B1942 - 23 -
1 application with information filed by the employer, the
2 employee or insurers with any other agency. This process
3 shall include guaranteeing confidentiality of employer
4 and employee information that is consistent with Federal
5 and State laws.
6 (f) Coordination.--The department shall coordinate with
7 other departments in the implementation of this section.
8 (g) Limitation on grants.--The total amount of grants
9 approved by the department shall not exceed the amount of
10 funding designated under section 762. Any application filed by
11 an employer when funding is not available shall not be
12 considered and cannot be carried forward for consideration in
13 any succeeding fiscal year.
14 (h) Lapse.--Funds not used by the department for CARE grants
15 at the end of the fiscal year shall lapse back to the Health
16 Care Provider Retention Account and be designated to the PA ABC
17 Program.
18 (i) Report to General Assembly.--The department shall submit
19 an annual report to the General Assembly indicating the
20 effectiveness of the program provided under this section no
21 later than March 15, 2010. The report shall include the names of
22 all the employers that received a CARE grant as of the date of
23 the report and the amount of each CARE grant approved. The
24 report may also include any recommendations for changes in the
25 calculation or administration of the CARE grant.
26 (j) Sunset.--This section shall sunset January 1, 2018.
27 (k) Definitions.--As used in this section, the following
28 words and phrases shall have the meanings given to them in this
29 subsection:
30 "CARE grant." A Continuing Access with Relief for Employers
20080S1356B1942 - 24 -
1 (CARE) grant provided by the Department of Community and
2 Economic Development.
3 "Coverage." Health care coverage that is maintained by an
4 employer for an employee, the employee's spouse and/or
5 dependents for 12 consecutive months.
6 "Department." The Department of Community and Economic
7 Development of the Commonwealth.
8 "Employee." An individual who meets the following:
9 (1) Is employed for more than 20 hours in a single week
10 and from whose wages an employer is required under the
11 Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C.
12 §1 et seq.) to withhold Federal income tax.
13 (2) Is at least 19 years of age but no older than 64
14 years of age.
15 (3) Legally resides within the United States.
16 (4) Has been domiciled in this Commonwealth for at least
17 90 days prior to enrollment.
18 (5) Has a household income that is no greater than 300%
19 of the Federal poverty level at the time of application.
20 "Employer." An employer that meets all of the following:
21 (1) Has at least two, but not more than 50 full-time
22 equivalent employees.
23 (2) Pays an average annual wage that is not greater than
24 300% of the Federal poverty limit for an individual.
25 "Health care coverage." A health benefit plan or other form
26 of health care coverage that is approved by the Department of
27 Community and Economic Development in consultation with the
28 Insurance Department. The term does not include coverage under
29 the PA ABC program.
30 "Health care expense." A payment made by an employer to
20080S1356B1942 - 25 -
1 maintain health care coverage for an employee, the employee's
2 spouse and/or dependents.
3 "Program." The Continuing Access with Relief for Employers
4 (CARE) Grant Program established under this section.
5 "Tax liability." Liability under Article III, IV or VI of
6 the act of March 4, 1971 (P.L.6, No.2), known as the Tax Reform
7 Code of 1971.
8 Section 12. The Insurance Department shall publish a notice
9 in the Pennsylvania Bulletin when a law is enacted that provides
10 for or designates at least $120,000,000 for the Supplemental
11 Assistance and Funding Account.
12 Section 13. The amendment of section 712(e) of the act shall
13 apply retroactively to December 31, 2007.
14 Section 14. This act shall take effect as follows:
15 (1) The following provisions shall take effect July 1,
16 2008, or immediately, whichever is later:
17 (i) The amendment of section 712(e) and (m) of the
18 act.
19 (ii) The amendment of the definition of "health care
20 provider" in section 1101 of the act.
21 (iii) The amendment of section 1112 of the act.
22 (iv) Section 12 of this act.
23 (2) The remainder of this act shall take effect upon
24 publication of the notice specified under section 12 of this
25 act.
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