THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY D. WHITE, PILEGGI, ALLOWAY, ERICKSON, ORIE, STACK AND PIPPY, FEBRUARY 24, 2009

REFERRED TO BANKING AND INSURANCE, FEBRUARY 24, 2009  

AN ACT

Establishing a system for payment or reduction in payment for

preventable serious adverse events within this Commonwealth;

and providing for the powers and duties of the Department of

Health and the Department of State.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

This act shall be known and may be cited as the Preventable

Serious Adverse Events Act.

Section 2.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Health care facility."  A health care facility as defined

under section 802.1 of the act of July 19, 1979 (P.L.130, No.

48), known as the Health Care Facilities Act, or an entity

licensed as a hospital under the act of June 13, 1967 (P.L.31,

No.21), known as the Public Welfare Code.

"Health care provider."  A health care facility or a person,

including a corporation, university or other educational

institution, licensed or approved by the Commonwealth to provide

health care or professional medical services as a physician, a

certified nurse midwife, a podiatrist, a certified registered

nurse practitioner, a physician assistant, a chiropractor, a

hospital, an ambulatory surgery center, a nursing home or a

birth center.

"Health payor."  An individual or entity paying for health

services on behalf of another.

"Medical assistance."  The Commonwealth's medical assistance

program established under the act of June 13, 1967 (P.L.31, No.

21), known as the Public Welfare Code.

"National Quality Forum."  A not-for-profit membership

organization created to develop and implement a national

strategy for health care quality measurement and reporting.

"Preventable serious adverse event."  An event that is within

the health care facility's control to avoid, but that occurs

because of an error or system failure, and results in a

patient's death, loss of body part, disfigurement, disability or

loss of bodily function lasting more than seven days or is still

present at the time of discharge from a health care facility.

Such events shall be within the list of reportable serious

events adopted by the National Quality Forum.

Section 3.  Payment policy for preventable serious adverse

events.

(a)  General rule.--Health care providers may not knowingly

seek payment from health payors, patients or the responsible

party of the patient for a preventable serious adverse event or

services required to correct or treat the problem created by an

event when the event occurred under their care or control.

(b)  Refunds.--A health care provider who discovers that

payment has been sought for a preventable serious adverse event

or services required to correct or treat the problem created by

such an event shall immediately notify the health payor, patient

or the responsible party of the patient and shall refund any

payment received within 30 days of discovery or receipt of

payment, whichever is later.

(c)  Liability.--A health care provider, in compliance with

this subsection, shall not constitute an acknowledgment or

admission of liability.

Section 4.  Duties of Department of Health.

In accordance with the act of July 19, 1979 (P.L.130, No.48),

known as the Health Care Facilities Act, the Department of

Health shall be responsible for investigating patient complaints

regarding a health care facility that is seeking payment from

the patient for a preventable serious adverse event.

Section 5.  Duties of Department of State.

The Department of State shall be responsible for

investigating patient complaints regarding a health care

provider that is not a health care facility that is seeking or

causing to be sought payment from the patient or responsible

party of the patient for a preventable serious adverse event.

Section 6.  Applicability.

(a)  Hospital medical assistance payment policy.--Nothing in

this act shall require the Department of Public Welfare to

alter, amend or reissue any payment policy for inpatient

hospitals relating to preventable serious adverse events that

was promulgated prior to the enactment of this act. Any

modifications of the Department of Public Welfare payment policy

issued after enactment of this act shall require a 60-day public

comment period.

(b)  Contracts.--Nothing in this act shall prohibit a health

care provider and payor from establishing by contract a payment

policy associated with serious preventable adverse events,

including policies related to payment reductions or medical

review of any events on the National Quality Forum serious

reportable event list.

(c)  Reporting.--Health care providers shall include all

applicable medical codes in making reports in compliance with

the act of July 8, 1986 (P.L.408, No.89), known as the Health

Care Cost Containment Act.

Section 7.  Effective date.

This act shall take effect in 180 days.