Regular Session 2019-2020 House Bill 0003 P.N. 2211

SENATE AMENDED

PRIOR PRINTER'S NOS. 1995, 2065

PRINTER'S NO. 2211

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

Session of

2019

INTRODUCED BY CUTLER, DERMODY, PICKETT, DeLUCA, WHEELAND,

SCHMITT, ROTHMAN, MOUL, MILLARD, BIZZARRO, BOYLE, BRADFORD,

BRIGGS, BULLOCK, BURGOS, BURNS, CALTAGIRONE, CARROLL, CEPHAS,

CIRESI, COMITTA, CONKLIN, DALEY, DAVIDSON, A. DAVIS,

T. DAVIS, DEASY, DELLOSO, DONATUCCI, FLYNN, FRANKEL, FREEMAN,

GAINEY, GALLOWAY, GOODMAN, HANBIDGE, HARKINS, HARRIS, HILL-

EVANS, HOWARD, INNAMORATO, ISAACSON, JOHNSON-HARRELL, KIM,

KINSEY, KIRKLAND, KORTZ, KOSIEROWSKI, KRUEGER, KULIK,

LONGIETTI, MALAGARI, MARKOSEK, MATZIE, McCARTER, McCLINTON,

McNEILL, MERSKI, MULLERY, MULLINS, NEILSON, O'MARA,

PASHINSKI, RAVENSTAHL, READSHAW, ROEBUCK, ROZZI, SAINATO,

SANCHEZ, SCHLOSSBERG, SHUSTERMAN, SIMS, SNYDER, SOLOMON,

STURLA, WARREN, WEBSTER, WHEATLEY, ZABEL, FITZGERALD, ULLMAN,

VITALI, WILLIAMS, DeLISSIO, ZIMMERMAN, SCHWEYER, DAWKINS,

HERSHEY, SAMUELSON, B. MILLER, MADDEN, KENYATTA AND ECKER,

JUNE 4, 2019

SENATOR SCAVELLO, BANKING AND INSURANCE, IN SENATE, AS AMENDED,

JUNE 24, 2019

AN ACT

Amending Title 40 (Insurance) of the Pennsylvania Consolidated

Statutes, providing for health insurance markets oversight;

and establishing the Pennsylvania Health Insurance Exchange

Fund.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Title 40 of the Pennsylvania Consolidated

Statutes is amended by adding a part to read:

PART V

HEALTH INSURANCE MARKETS OVERSIGHT

Chapter

91. Preliminary Provisions

93. State-based Exchange

95. Reinsurance Program

97. Miscellaneous Provisions

CHAPTER 91

PRELIMINARY PROVISIONS

Sec.

9101. Scope of part.

9102. Purpose and intent.

9103. Definitions.

§ 9101. Scope of part.

This part relates to health insurance markets oversight.

§ 9102. Purpose and intent.

The General Assembly finds and declares as follows:

(1) The Commonwealth intends to maintain the

Commonwealth's sovereignty over the regulation of health

insurance in this Commonwealth.

(2) The health insurance marketplace in this

Commonwealth is unique and unlike the marketplace in any

other state.

(3) It is necessary to maintain the Commonwealth's

sovereignty over the regulation of health insurance in this

Commonwealth as permitted by Federal law, including the

Federal acts. The provisions of this part are intended to

meet these requirements while retaining the Commonwealth's

authority to regulate health insurance in this Commonwealth.

§ 9103. Definitions.

Subject to additional definitions contained in subsequent

provisions of this part which are applicable to specific

provisions of this part, the following words and phrases when

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used in this part shall have the meanings given to them in this

section unless the context clearly indicates otherwise:

"Affordable Care Act." The Patient Protection and Affordable

Care Act (Public Law 111-148, 124 Stat. 119), as amended by the

Health Care and Education Reconciliation Act of 2010 (Public Law

111-152, 124 Stat. 1029).

"Attachment point." The threshold amount for claims costs

incurred by an eligible insurer for an enrolled individual's

covered benefits in a benefit year, above which the claims costs

for benefits are eligible for reinsurance payments under this

part.

"Benefit year." The calendar year during which an eligible

insurer provides coverage through a health care plan.

"Board." The governing body of the exchange authority.

"Children's Health Insurance Program." The children's health

insurance program under Article XXIII-A of the act of May 17,

1921 (P.L.682, No.284), known as The Insurance Company Law of

1921.

"Coinsurance rate." The percentage rate at which the

reinsurance program will reimburse an eligible insurer for

claims incurred for an enrollee's covered benefits in a benefit

year above the attachment point and below the reinsurance cap.

"Commissioner." The Insurance Commissioner of the

Commonwealth.

"Department." The Insurance Department of the Commonwealth.

"Eligible insurer." An insurer offering reinsurance-eligible

health care plans to consumers in this Commonwealth.

"Enrollee." A policyholder, certificate holder, subscriber,

covered person or other individual who is enrolled to receive

health care services pursuant to a health insurance policy.

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"Exchange." A health insurance exchange as contemplated by

section 1321(b) of the Affordable Care Act, established or

operating in this Commonwealth, that facilitates or assists in

facilitating enrollment in qualified plans.

"Exchange assister." The term has the meaning given to it in

section 2 of the act of June 19, 2015 (P.L.25, No.7), known as

the Navigator and Exchange Assister Accessibility and Regulation

Act.

"Exchange authority." The Pennsylvania Health Insurance

Exchange Authority established under section 9302(a) (relating

to Pennsylvania Health Insurance Exchange Authority).

"Exchange fund." The Pennsylvania Health Insurance Exchange

Fund established under section 9312 (relating to exchange fund).

"Federal acts." The Affordable Care Act and any amendments

thereto, and related provisions of the Public Health Service Act

(58 Stat. 682, 42 U.S.C. § 201 et seq.).

"Government program." A program of government sponsored or

subsidized health care coverage, including:

(1) A premium tax credit or cost-sharing subsidy under

the Federal acts.

(2) Coverage under Medicare Parts A and B or Medicare

Advantage Part C under Title XVIII of the Social Security Act

(49 Stat. 620, 42 U.S.C. § 1395 et seq.).

(3) A TRICARE or other health care plan provided through

the Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS) as defined under 10 U.S.C. § 1072

(relating to definitions).

(4) A health care plan provided through the Federal

Employees Health Benefits Program established under 5 U.S.C.

Ch. 89 (relating to health insurance).

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(5) The Commonwealth's medical assistance program

established under the act of June 13, 1967 (P.L.31, No.21),

known as the Human Services Code.

(6) The Children's Health Insurance Program.

(7) Health care coverage provided by the Commonwealth, a

county, a city, or other State or local governmental entity

or an agency, subdivision or department of a governmental

entity, including:

(i) a corporation or other arrangement organized by

the entity for the provision of health care coverage and

subject to control by the entity or an instrumentality of

one or more of them;

(ii) the Pennsylvania Employee Benefit Trust Fund

for active and retired employees; and

(iii) benefit programs administered by the

Department of Corrections.

"Grandfathered health care plan." Individual or group health

insurance coverage in which an individual was enrolled prior to

the date of enactment of the Affordable Care Act, or as

otherwise specified in section 1251 of the Affordable Care Act

(42 U.S.C. § 18011).

"Health care plan." A package of coverage benefits with a

particular cost-sharing structure, network and service area that

is purchased through a health insurance policy.

"Health insurance policy." A policy, subscriber contract,

certificate or plan issued by an insurer that provides hospital

or medical/surgical health care coverage. The term does not

include any of the following:

(1) An accident only policy.

(2) A credit only policy.

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(3) A long-term care or disability income policy.

(4) A specified disease policy.

(5) A Medicare supplement policy.

(6) A fixed indemnity policy.

(7) An adult-only dental only policy.

(8) A vision only policy.

(9) A workers' compensation policy.

(10) An automobile medical payment policy.

(11) A policy under which benefits are provided by the

Federal Government to active or former military personnel and

their dependents.

(12) Any other similar policies providing for limited

benefits.

"Hospital plan corporation." An entity organized and

operating under Chapter 61 (relating to hospital plan

corporations).

"Individual market." The market for health insurance

coverage offered to individuals other than in connection with a

group.

"Innovation waiver." A waiver applied for pursuant to

section 1332 of the Affordable Care Act (42 U.S.C. §18052).

"Insurance producer." The term has the meaning given to it

in section 601-A of the act of May 17, 1921 (P.L.789, No.285),

known as The Insurance Department Act of 1921.

"Insurer." An entity that offers, issues or renews an

individual or group health, accident or sickness insurance

policy, contract or plan, and that is governed under any of the

following:

(1) Chapter 61.

(2) Chapter 63 (relating to professional health services

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plan corporations).

(3) The Insurance Company Law of 1921, including section

630 and Article XXIV.

(4) The act of December 29, 1972 (P.L.1701, No.364),

known as the Health Maintenance Organization Act.

"Medical assistance program." The Commonwealth's medical

assistance program established under the Human Services Code.

"Professional health services plan corporation." An entity

organized and operating under Chapter 63.

"Qualified enrollee." A qualified employee or qualified

individual, as defined in section 1312(f) of the Affordable Care

Act and regulations promulgated under that act.

"Qualified plan." A plan as defined in section 1301(a) of

the Affordable Care Act that provides health care or dental care

coverage that has been certified by the department as meeting

the criteria set forth in this part and any regulations issued

pursuant to this part.

"Reinsurance cap." The upper limit amount for claims costs

incurred by an eligible insurer for an enrolled individual's

covered benefits in a benefit year, over which the claims costs

for benefits are no longer eligible for reinsurance payments

under the reinsurance program.

"Reinsurance-eligible enrollee." An enrollee who is insured

in a reinsurance-eligible health care plan under this part.

"Reinsurance-eligible health care plan." A health care plan

that is not a grandfathered health care plan.

"Reinsurance payment." An amount paid by the reinsurance

program to an eligible insurer under the program.

"Reinsurance program." The Commonwealth Health Insurance

Reinsurance Program established under section 9502(b) (relating

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to implementation of waiver and establishment of reinsurance

program).

"Small group market." The market for health insurance for

coverage offered through a group health insurance policy for a

group of at least one employee and up to 50 employees , exclusive

of dependents.

CHAPTER 93

STATE-BASED EXCHANGE

Sec.

9301. Scope of chapter.

9302. Pennsylvania Health Insurance Exchange Authority.

9303. Advisory council.

9304. Meetings and operation.

9305. Powers and duties of exchange authority.

9306. Limitations.

9307. Confidentiality and disclosure.

9308. Not an entitlement.

9309. Nonliability.

9310. Audits.

9311. Reports.

9312. Exchange fund.

9313. Federal guidance.

9314. Expiration.

§ 9301. Scope of chapter.

This chapter relates to the Pennsylvania Health Insurance

Exchange Authority.

§ 9302. Pennsylvania Health Insurance Exchange Authority.

(a) Establishment.--The Pennsylvania Health Insurance

Exchange Authority is established as a State-affiliated entity.

The powers and duties of the exchange authority shall be vested

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in and exercised by a board, which shall have the sole power

under section 9305 (relating to powers and duties of exchange

authority) to employ staff, including an executive director.

Individuals employed by the exchange authority shall be

employees of the Commonwealth. The exchange authority may

contract with persons or entities, including legal counsel,

consultants or service providers, as deemed necessary in the

exchange authority's discretion.

(b) Purpose.--The purpose of the exchange authority shall be

to create, manage and maintain in this Commonwealth the

Pennsylvania Health Insurance Exchange to do all of the

following:

(1) Benefit the Pennsylvania health insurance market and

persons enrolling in health insurance policies.

(2) Facilitate or assist in facilitating the purchase of

on-exchange qualified plans by qualified enrollees in the

individual market or the individual and small group markets.

members:

(1) Three voting members who shall be the following

heads of agencies or a designee who shall be an employee of

the agency designated in writing by the head of the agency

prior to service:

(i) The commissioner, ex-officio.

(ii) The Secretary of Human Services, ex-officio.

(iii) The Secretary of Health, ex-officio.

(2) Four voting members appointed by the Governor:

(i) One member from among the insurers that offer

health insurance policies through the exchange that are a

hospital plan corporation, a professional health services

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plan corporation or a parent, affiliate, subsidiary or

other associated entity or successor of a hospital plan

corporation or a professional health services plan.

(ii) One member from among the insurers that offer

health insurance policies through the exchange that are

not a hospital plan corporation, a professional health

services plan corporation or a parent, affiliate,

subsidiary or other associated entity or successor of a

hospital plan corporation or a professional health

services plan.

(iii) One member with experience in health care

public education and consumer assistance activities who

does not have a conflict of interest as described in

subsection (k).

(iv) One member who is a consumer representative.

(3) Four voting members appointed by the General

Assembly each with relevant experience in health benefits

administration, health care finance, health care plan

purchasing, health care delivery system administration,

public health or health policy related to the individual and

small group markets and the uninsured: AS FOLLOWS:

(i) One member INDIVIDUAL appointed by the President

pro tempore of the Senate.

(ii) One member INDIVIDUAL appointed by the Minority

Leader of the Senate.

(iii) One member INDIVIDUAL appointed by the Speaker

of the House of Representatives.

(iv) One member INDIVIDUAL appointed by the Minority

Leader of the House of Representatives.

(4) The executive director shall attend meetings of the

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board but shall not be a member, may not vote and may not be

counted for purposes of establishing a quorum.

(d) Chairperson.--The commissioner or a designee shall serve

as chairperson.

(e) Compensation.--Board members shall not be entitled to

any compensation for their services as members, except that,

subject to the availability of funds, board members shall be

entitled to reimbursement for actual and necessary travel

expenses. The expenses shall be paid for by the exchange fund.

(f) Terms.--The terms of the board members shall be as

follows:

(1) A board member appointed under subsection (c) (3)

who:

(i) Is a member of the General Assembly shall serve

a term concurrent with their holding of public office.

(ii) Is not a member of the General Assembly shall

serve a term concurrent with their appointing official's

holding of public office.

(2) A board member appointed under subsection (c) (2)

shall serve a term of four years, not to exceed more than two

full consecutive four-year terms, except that the following

shall apply:

(i) Initial appointments shall be so staggered that

less than 50% of the membership shall expire each year.

(ii) A member's term shall continue until the

member's replacement is appointed.

(g) Vacancies.--Vacancies in appointed positions shall be

filled in the same manner as the original appointment. Members

shall serve until their successors are appointed and qualified.

(h) Formation.--The exchange authority shall be formed

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within 60 days of the effective date of this section. Prior to

formation of the exchange authority, the commissioner may take

action necessary to effect a timely transition from a federally

administered exchange to the Pennsylvania Health Insurance

Exchange.

(i) Quorum.--A majority of the appointed members of the

board shall constitute a quorum. Action may be taken by the

board at a meeting upon a vote of a quorum of its members

present in person or through electronic means. If a tie vote

occurs at any meeting, it shall be the duty of the chairperson

of the board to cast a second and deciding vote.

(j) Meetings.--The board shall meet at the call of the

chairperson or as may be provided in the bylaws of the board.

The board shall hold meetings at least quarterly, which shall be

subject to the requirements of 65 Pa.C.S. Ch. 7 (relating to

open meetings).

(k) Experience and interests.--For purposes of this chapter,

the board shall assure that it complies with section 1321 of the

Affordable Care Act (42 U.S.C. § 18041) and regulations

promulgated under the Affordable Care Act regarding conflicts of

interest and relevant experience.

(l) Conflict of interest.--The following apply:

(i) (1 ) Except as provided under subparagraph (ii)

PARAGRAP H (2) , a non-State employee board member shall not be

subject to 65 Pa.C.S. Ch. 11 (relating to ethics standards

and financial disclosure), including the requirements for

filing statements of financial interests.

(ii) (2) A non-State employee board member may not

engage in conduct that, if that member were a State employee,

would constitute a conflict of interest under 65 Pa.C.S. Ch.

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11.

(iii) (3) A majority of the voting members of the board

may not have a conflict of interest as set forth in section

1321 of the Affordable Care Act and regulations promulgated

under the Affordable Care Act.

§ 9303. Advisory council.

(a) Establishment.--An advisory council is created to advise

the exchange authority under section 9304(g) (relating to

meetings and operation).

(b) Composition.--The advisory council shall consist of the

following members, who may not be in the employ of the

Commonwealth:

(1) Four consumer representatives which include two

representatives appointed by the Governor at least one of

whom shall be a registered insurance exchange navigator or

assister, one appointed by the President pro tempore of the

Senate and one appointed by the Speaker of the House of

Representatives.

(2) One representative selected by the Hospital and

Healthsystem Association of Pennsylvania.

(3) One representative selected by the Pennsylvania

Medical Society.

(4) One representative selected by the Pennsylvania

Chamber of Business and Industry from a small group employer.

(5) One representative selected by the Pennsylvania

Association of Health Underwriters.

§ 9304. Meetings and operation.

(a) Chairperson.--The members of the advisory council shall

annually elect a chairperson from among its membership.

(b) Terms of members.--Each member's term shall be four

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years, not to exceed more than two full consecutive four-year

terms, except that:

(1) Initial appointments shall be staggered to ensure

less than 50% of the membership expire each year.

(2) A member's term shall continue until the member's

successor is appointed.

conducted in accordance with 65 Pa.C.S. Ch. 7 (relating to open

meetings), except as provided in this section. Meetings must be

held in accordance with the following:

(1) The advisory council shall meet at least twice per

year, with each meeting held prior to a meeting of the board.

Additional meetings may be held upon reasonable notice at

times and locations selected by the board. The council shall

meet at the call of the chairperson or upon written request

of three members of the council.

(2) The executive director of the exchange authority, or

a designee, shall attend each meeting of the advisory

council.

(3) Meeting dates shall be set by a majority vote of

members of the advisory council or by call of the chairperson

upon seven days' notice to all members.

(4) The advisory council shall post notice of the

council's meetings on the exchange authority's publicly

accessible Internet website at least five days prior to each

meeting. The notice must specify the date, time and place of

the meeting and shall state that the council's meetings are

open to the general public.

(5) All action taken by the advisory council shall be

taken in open public session and may not be taken except upon

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a majority vote of the members present at a meeting at which

a quorum is present.

(d) Compensation.--The members of the advisory council shall

not be entitled to any compensation for their services as

members, except that, subject to the availability of money, the

members of the advisory council shall be entitled to

reimbursement for actual and necessary travel expenses. The

expenses shall be paid for by the exchange fund.

(e) Vacancies.--Vacancies in appointed positions shall be

filled in the same manner as the original appointment. Members

shall serve until their successors are appointed and qualified.

(f) Quorum.--A majority of the advisory council members

shall constitute a quorum and a quorum may act for the advisory

council in all matters.

(g) Duties.--Upon request by the exchange authority, the

advisory council shall advise the exchange authority on the

following administrative and operational decisions:

(1) Initial operational decisions.

(2) Ongoing financing decisions.

(3) Other decisions as the exchange authority may deem

appropriate.

§ 9305. Powers and duties of exchange authority.

(a) Corporate operations.--The exchange authority shall

exercise all powers and duties necessary and appropriate to

carry out its purpose, including the following:

(1) Adopt bylaws.

(2) Employ staff.

(3) Make, execute and deliver contracts.

(4) Apply for, solicit and receive money from any source

consistent with the purpose of this chapter.

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(5) Establish priorities for, allocate and disburse

money received.

(6) Submit annually to the Appropriations Committee of

the Senate and the Appropriations Committee of the House of

Representatives, at the same time the exchange authority

submits its budget to the Governor, a copy of its budget

request and all subsequently revised budget requests for the

ensuing fiscal year. The budget shall include the amounts to

be appropriated out of the fund established under section

9312 (relating to exchange fund) necessary to administer the

provisions of this chapter and the conveyance of money to the

Reinsurance Fund established under section 9510 (relating to

Reinsurance Fund).

(7) Establish travel reimbursement policies for the

exchange authority, its board, and its advisory council.

(8) Coordinate with the appropriate Federal and State

agencies to seek waivers from statutory or regulatory

requirements as necessary to carry out the purposes of this

chapter.

(9) Enter into other arrangements, including without

limitation, interagency agreements with Federal agencies and

Commonwealth agencies or other states' agencies, as may be

necessary or appropriate to carry out the duties of the

exchange authority.

(10) Give reasonable public notice of any policies and

procedures the exchange authority may implement to accomplish

the operation of the exchange authority.

(11) Perform other operational activities necessary or

appropriate to further the purposes of this chapter.

(12) The board shall consider the advice of the advisory

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council provided under section 9304(g) (relating to meetings

and operation).

(b) Programmatic duties.--The exchange authority shall

perform all duties necessary or appropriate to advance its

purpose, including the following:

(1) Educate consumers, including through outreach, a

navigator program and postenrollment support.

(2) Assist individuals to access income-based assistance

for which they may be eligible, including premium tax

credits, cost-sharing reductions and government programs.

(3) Take into consideration the need for consumer choice

in rural, urban and suburban areas across the Commonwealth.

(4) Assess and collect fees from on-exchange insurers to

support the operation of the exchange under this chapter and

the reinsurance program established under section 9502(b)

(relating to implementation of waiver and establishment of

reinsurance program), except that the exchange authority may

not assess or collect any form of obligation other than an

exchange user fee on total monthly premiums for on-exchange

policies and unless approved by unanimous consent of the

board, the fee may not exceed 3% of total monthly premiums

for on-exchange policies. IN NO CASE MAY THE FEE EXCEED 3.5%.

(5) Disburse receipted fees, including to benefit the

reinsurance program established under section 9502(b).

authority shall ensure that the exchange complies with the

Federal acts and rules and regulations that may be imposed by

the Federal Government pursuant to the Federal acts in a manner

that maintains State sovereignty over the health insurance

market in this Commonwealth. Enforcement responsibilities shall

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be delegated to the appropriate State agency and shall be

sufficient to prevent a determination by the United States

Secretary of Health and Human Services that the Commonwealth has

failed to substantially enforce any provision of the Federal

acts.

§ 9306. Limitations.

Except as expressly provided in this chapter, nothing in this

chapter shall be construed to limit or supersede the authority

vested in a Commonwealth agency, including:

(1) The Insurance Department, including the department's

authority to regulate the business of insurance within this

Commonwealth, including health insurance policies whether

offered on or off the exchange.

(2) The Department of Human Services, including with

respect to the medical assistance program or the Children's

Health Insurance Program.

(3) The Department of Health.

(4) The Office of Attorney General.

§ 9307. Confidentiality and disclosure.

(a) General rule.--Except as provided in this chapter, all

working papers, recorded information, documents and copies of

working papers, recorded information and documents produced by,

obtained by or disclosed to the exchange authority or any other

person in the course of the exercise of the exchange authority's

powers and duties under this chapter:

(1) shall be confidential;

(2) shall not be subject to subpoena;

(3) shall not be subject to the act of February 14, 2008

(P.L.6, No.3), known as the Right-to-Know Law;

(4) shall not be subject to discovery or admissible in

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evidence in any private civil action; and

(5) may not be made public by the exchange authority or

any other person.

(b) Personal health and financial information.--The exchange

authority shall protect personally identifiable health and

financial information in accordance with all applicable Federal

and State laws and regulations, including the Health Insurance

Portability and Accountability Act of 1996 (Public Law 104-191,

110 Stat. 1936), the Health Information Technology for Economic

and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and

467-496) and implementing regulations.

provisions of this section:

(1) Information shall be shared, as appropriate, for the

purpose of determining and coordinating the eligibility of

individuals for the exchange or any government program,

including the Children's Health Insurance Program and medical

assistance program, or for compliance with Federal law:

(i) Among the exchange authority and departments,

including:

(A) The department.

(B) The Department of Aging.

(D) The Department of Health.

(E) The Department of Human Services.

(F) The Department of Labor and Industry.

(G) The Department of Revenue.

(ii) Between the exchange authority and Federal

agencies, including:

(A) The Centers for Medicare and Medicaid

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Services.

(B) The Treasury Department.

(2) Information may be disclosed:

(i) As necessary to comply with the audit

requirements of section 9310 (relating to audits) and the

reporting requirements of section 9311 (relating to

reports), only in an aggregated and de-identified form.

(ii) In any circumstance, other than those described

in paragraph (1) or subparagraph (i), only if the prior

written consent of the company or person to which the

information pertains has been obtained.

(d) Construction.--Nothing in this section shall be

construed to prohibit the exchange authority from accessing the

information necessary to carry out its responsibilities in

accordance with law.

§ 9308. Not an entitlement.

Nothing in this chapter shall constitute an entitlement

derived from the Commonwealth or a claim on any money of the

Commonwealth.

§ 9309. Nonliability.

(a) General rule.--Except as provided under subsection (b),

there shall be no liability on the part of and no cause of

action of any nature may arise against the exchange authority,

board or advisory council or members thereof, the commissioner,

the department, an insurer, insurance producer or an exchange

assister or an authorized representative, agent or employee

thereof, for the use of information furnished pertaining to:

(1) An application for, inquiry concerning, or

enrollment or disenrollment in a health insurance policy or

government program, including an inquiry regarding

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eligibility for enrollment or eligibility for a government

program, relevant to health insurance available through an

exchange or health care coverage or other benefits through a

government program.

(2) A charge, assessment or fee imposed on or received

from a person or entity relevant to the exchange.

(b) Limitation.--Subsection (a) shall apply only insofar as

the person or entity is acting within the scope of the person's

or entity's duties and responsibilities under this chapter.

§ 9310. Audits.

(a) Annual audit.--The accounts and books of the exchange

authority shall be examined and audited annually by an

independent certified public accounting firm. The audit shall at

a minimum:

(1) Assess compliance with the requirements of this

chapter.

(2) Identify any material weaknesses or significant

deficiencies and identify ways to correct the material

weaknesses or deficiencies.

(b) Sharing of audit.--By December 31 of each year, the

exchange authority shall electronically share the audit of the

preceding fiscal year required under subsection (a) and related

documents by:

(1) Posting the following on the exchange authority's

publicly accessible Internet website:

(i) The audit.

(ii) A summary of the audit, including any material

weakness or significant deficiency identified and how the

exchange authority intends to correct the material

weakness or significant deficiency.

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(2) Providing an electronic link to the posted audit

under paragraph (1)(i) to the Secretary of the Senate and the

Chief Clerk of the House of Representatives.

(3) Providing an electronic link to the posted audit

under paragraph (1)(i) to the department.

subsection (a) shall be paid for from money in the exchange

fund.

§ 9311. Reports.

(a) Report.--The exchange authority shall prepare an annual

report on the activities of the exchange authority for the year

and:

(1) Electronically transmit the report to:

(i) The Governor.

(ii) The President pro tempore of the Senate.

(iii) The Minority Leader of the Senate.

(iv) The Speaker of the House of Representatives.

(v) The Minority Leader of the House of

Representatives.

(vi) The chair and minority chair of:

(A) The Appropriations Committee of the Senate.

(B) The Appropriations Committee of the House of

Representatives.

Senate.

(D) The Insurance Committee of the House of

Representatives.

(E) The Health and Human Services Committee of

the Senate.

(F) The Health Committee of the House of

20190HB0003PN2211 - 22 -

Representatives.

(2) Post the report on the exchange authority's publicly

accessibility ACCESSIBLE Internet website.

(b) Federal compliance.--The exchange authority shall comply

with applicable Federal reporting requirements.

provide a copy of or electronic link to the report provided

under subsection (a) or (b) to the department.

§ 9312. Exchange fund.

(a) Establishment.--The Pennsylvania Health Insurance

Exchange Fund is established as a special fund within the State

Treasury. The exchange fund shall be administered by the

exchange authority for the purposes set forth in this chapter,

including the deposit of money that may be received pursuant to

and disbursements permitted by this chapter.

(b) Deposit and use of money.--The following apply:

(1) Money deposited into the exchange fund shall be held

for the purposes set forth in this chapter and may not be

considered a part of the General Fund.

(2) Money in the exchange fund may only be used to

effectuate the purposes of this chapter as determined by the

exchange authority.

(3) All interest earned from the investment or deposit

of money in the exchange fund shall be deposited into the

exchange fund.

(4) All accrued and future earnings from money invested

by the exchange authority and other accrued and future

earnings from nonappropriated money, including, but not

limited to, money obtained from the Federal Government and

fees, shall be available to the exchange authority and shall

20190HB0003PN2211 - 23 -

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be deposited into the State Treasury and may be utilized at

the discretion of the board for carrying out any of the

corporate purposes of the exchange authority.

(5) Placement of money by the State Treasurer in

depositories or investments shall be consistent with

guidelines approved by the board.

(6) For the purpose of administration, the exchange

authority shall be subject to sections 610, 613 and 614 of

act of April 9, 1929 (P.L.177, No.175), known as The

Administrative Code of 1929.

be a nonlapsing fund. All money in the exchange fund and

interest accrued are appropriated to the exchange authority for

expenditure consistent with this chapter.

§ 9313. Federal guidance.

Until the exchange authority promulgates regulations, the

exchange authority shall operate the exchange pursuant to:

(1) any applicable Federal rules, regulations or

guidance; or

(2) interim State guidelines consistent with this

chapter.

§ 9314. Expiration.

Upon publication of the notice under section 9703(b)

(relating to action by commissioner), the exchange authority

shall initiate steps to cease operations of the exchange

authority and shall cease operations not later than 15 months

after publication of the notice.

CHAPTER 95

REINSURANCE PROGRAM

Sec.

20190HB0003PN2211 - 24 -

9501. Application.

9502. Implementation of waiver and establishment of reinsurance

program.

9503. Administration and operation of reinsurance program.

9504. Reinsurance parameters.

9505. Insurer eligibility and duties.

9506. Payment of coverage and administrative costs.

9507. Not an entitlement.

9508. Annual audit.

9509. Annual report of operations.

9510. Reinsurance Fund.

9511. Procurements within one year.

9512. Access to information and records.

9513. Confidentiality and information disclosure.

9514. Immunity.

9515. Regulation of insurers.

9516. Expiration.

§ 9501. Application.

(a) Application.--The department is authorized to apply to

the United States Secretary of Health and Human Services under

section 1332 of the Affordable Care Act for a state innovation

waiver to:

(1) Waive any applicable provisions of the Affordable

Care Act with respect to health insurance coverage in this

Commonwealth.

(2) Establish a reinsurance program in accordance with

an approved waiver.

(3) Maximize Federal funding for the reinsurance program

for plan years beginning on or after implementation of the

program.

20190HB0003PN2211 - 25 -

(b) Public review.--On or before 180 days after the

effective date of this section, the department shall make a

draft application available for a 30-day public review and

comment period. The department shall consider any comments in

its final submitted application.

application as necessary to carry out the provisions of this

chapter.

(d) Notification.--The department shall notify the chair and

minority chair of the Appropriations Committee of the Senate,

the chair and minority chair of the Appropriations Committee of

the House of Representatives, the chair and minority chair of

the Banking and Insurance Committee of the Senate and the chair

and minority chair of the Insurance Committee of the House of

Representatives promptly of any amendment to the waiver

application and of any Federal actions regarding the waiver

application.

§ 9502. Implementation of waiver and establishment of

reinsurance program.

(a) Implementation.--Upon approval of the department's

application for an innovation waiver by the United States

Department of Health and Human Services, the department shall

implement a reinsurance program.

(b) Establishment.--Contingent upon Federal approval, the

Commonwealth Health Insurance Reinsurance Program is established

in the department for the purposes of stabilizing the rates and

premiums for health insurance policies in the individual market

and providing greater financial certainty to consumers of health

insurance in this Commonwealth. The reinsurance program shall be

considered a reinsurance entity to carry out a reinsurance

20190HB0003PN2211 - 26 -

program under the Federal acts.

contingent on Federal approval of the waiver application

submitted pursuant to section 9501 (relating to application).

§ 9503. Administration and operation of reinsurance program.

(a) General rule.--The department shall take all actions

necessary to administer the approved reinsurance program in a

manner consistent with applicable Federal and State law.

(b) Functions.--The department shall perform all functions

necessary and appropriate to carry out the operation of the

reinsurance program and to effectuate the purposes for which the

reinsurance program is organized, in accordance with the

approved waiver. The functions include:

(1) Establishing procedures for and performing

administrative and accounting operations of the reinsurance

program.

(2) Seeking and receiving funding for the reinsurance

program and to maximize Federal funding for the reinsurance

program, including from:

(i) The exchange authority.

(ii) Federal funding that is or becomes available to

states to support administration and implementation of

state-based reinsurance programs.

(iii) Other available sources.

(3) Collecting data submissions and reinsurance payment

requests by eligible insurers.

(4) Making reinsurance payments to eligible insurers.

(5) Resolving disputes related to the amount of

reinsurance payments.

(6) Suing or being sued, including taking any legal

20190HB0003PN2211 - 27 -

action necessary or proper for the recovery of money for

reinsurance payments.

(7) Submitting invoices or other requests for money as

may be necessary and appropriate under the innovation waiver.

law and regulation, and as may be necessary or appropriate to

carry out department duties, the department may administer the

reinsurance program directly or through:

(1) Other Federal agencies, Commonwealth agencies or

other states' agencies.

(2) Contracted persons or entities, including with

legal, actuarial, economic, third-party administrator or

other persons or entities, as the department deems

appropriate, to provide consultation services and technical

assistance in operating the reinsurance program. Contracted

persons or entities shall submit regular reports to the

department regarding the person's or entity's performance,

the frequency, content and form of which shall be determined

by the department.

(d) Coordination with exchange authority.--The department

shall coordinate with the exchange authority as may be necessary

to fund and operate the reinsurance program.

§ 9504. Reinsurance parameters.

(a) Adoption of reinsurance terms.--The department shall,

after consultation with all insurers then currently

participating in the exchange, and not less than 60 days before

final rates for health insurance policies are required to be

submitted each year, determine and adopt the attachment point,

reinsurance cap and coinsurance rate applicable to the

reinsurance program for the following year.

20190HB0003PN2211 - 28 -

(b) Parameters.--In determining the attachment point,

reinsurance cap and coinsurance rate applicable to the

reinsurance program for the following year, the department shall

seek to:

(1) Manage the program within the amount of total

program funding available to the department.

(2) With respect to the individual market:

(i) Mitigate the impact of high-cost claims on

premium rates.

(ii) Stabilize or reduce premium rates.

(iii) Increase participation.

notice of the adopted attachment point, reinsurance cap and

coinsurance rate to the Legislative Reference Bureau for

publication in the Pennsylvania Bulletin and shall:

(1) Post notice on the department's publicly accessible

Internet website.

(2) Electronically send notice to the chair and minority

chair of the Banking and Insurance Committee of the Senate

and the chair and minority chair of the Insurance Committee

of the House of Representatives.

(3) Electronically send notice to each participating

insurer via a contact person or electronic mailing address,

as identified by the insurer.

(d) Limitation.--After the department adopts the attachment

point, reinsurance cap and coinsurance rate for the next year,

the department may not, before or during that benefit year,

change the attachment point, reinsurance cap or coinsurance rate

in a manner less favorable to the insurers participating in the

exchange at the time of adoption.

20190HB0003PN2211 - 29 -

§ 9505. Insurer eligibility and duties.

(a) Eligibility for payment.--An insurer shall be eligible

for a reinsurance payment if:

(1) The claims costs for a reinsurance-eligible

enrollee's covered benefits in a benefit year exceed the

attachment point.

(2) The eligible insurer has implemented and documented

reasonable care management practices for enrollees who are

the subject of reinsurance claims through the reinsurance

program.

(3) The eligible insurer makes its requests for

reinsurance payments in accordance with any requirements

established by the department including requirements related

to the format, structure and timing for submission of claims

for reinsurance payments.

(4) The eligible insurer participated in the exchange,

or is affiliated with an entity that participated in the

exchange, in the benefit year in which the claims costs for

which a reinsurance payment is sought were incurred.

(b) Reporting requirement.--An insurer that seeks

reinsurance payments under this chapter must report to the

department, in the form and manner prescribed by the department,

information about reinsurance-eligible enrollees insured by the

insurer as necessary for the department to calculate reinsurance

payments.

this section are confidential and are not subject to public

disclosure, except as provided under section 9514 (relating to

immunity).

(d) Consideration for rate filings.--In a rate filing for a

20190HB0003PN2211 - 30 -

health insurance policy to be offered through the exchange, the

impact of reinsurance payments under this chapter shall be

identified.

(e) Limitation.--The calculation of reinsurance payments due

to an eligible insurer shall be net of all other available

insurance payments applicable to a claim, including insurance

accessible through subrogation or coordination of benefits.

§ 9506. Payment of coverage and administrative costs.

(a) General rule.--Consistent with Federal requirements, the

department shall pay the following from the Reinsurance Fund:

(1) Administrative expenses of the reinsurance program,

including the annual audit required under section 9508

(relating to annual audit).

(2) Reinsurance payments for coverage of reinsurance-

eligible enrollees.

(b) Operations.--The department may promulgate regulations

necessary and appropriate to establish processes for the

settlement of reinsurance coverage claims and disbursement of

reinsurance money.

determination of the department relating to the amount of

reinsurance payments due to the insurer may file a request for

administrative review of the decision. The procedures and

requirements of 2 Pa.C.S. Ch. 5 Subch. A (relating to practice

and procedure of Commonwealth agencies) shall apply to requests

for review filed under this section. Notwithstanding otherwise

applicable time limitations, in order to permit timely

finalization of rates for the open enrollment period for the

exchange, a challenge to the department's determination of the

attachment point, reinsurance cap and coinsurance rate published

20190HB0003PN2211 - 31 -

in the Pennsylvania Bulletin under section 9504(c) (relating to

reinsurance parameters) must be made within 10 business days of

the date of publication.

§ 9507. Not an entitlement.

(a) No entitlement.--The provision of reinsurance program

money or benefits accrued through the Reinsurance Fund may not

constitute an entitlement derived from the Commonwealth or a

claim on any other money of the Commonwealth.

(b) Contingency with respect to Federal money.--

Notwithstanding any provision of this chapter, the department

shall have no responsibility to pay reinsurance amounts that

would be payable out of Federal money if the Federal Government

does not transmit sufficient money for the Reinsurance Fund to

fully recompense those actions.

§ 9508. Annual audit.

(a) Annual audit.--The reinsurance program shall be examined

and audited annually by an independent certified public

accounting firm. The audit shall, at a minimum:

(1) Assess compliance with the requirements of this

chapter.

(2) Identify any material weaknesses or significant

deficiencies and identify and implement solutions to correct

the the material weaknesses or deficiencies.

(b) Sharing of audit.--By December 31 of each year, the

department shall electronically share the audit of the preceding

fiscal year required under subsection (a) and related documents

by:

(1) Posting the following on the department's publicly

accessible Internet website:

(i) The audit.

20190HB0003PN2211 - 32 -

(ii) A summary of the audit, including any material

weakness or significant deficiency identified and how the

department intends to correct the material weakness or

significant deficiency.

(2) Providing an electronic link to the posted audit

under paragraph (1)(i) to the Secretary of the Senate and the

Chief Clerk of the House of Representatives.

subsection (a) shall be paid for from money in the Reinsurance

Fund.

§ 9509. Annual report of operations.

(a) Report.--No later than November 1 of the year following

the applicable benefit year or 60 calendar days following the

final disbursement of reinsurance payments for the applicable

benefit year, whichever is later, the department shall prepare a

financial report for the applicable benefit year. The report

must include, at a minimum, the following information for the

benefit year that is the subject of the report:

(1) Money deposited into the Reinsurance Fund.

(2) Requests for reinsurance payments received from

eligible insurers.

(3) Reinsurance payments made to eligible insurers.

(4) Administrative and operational expenses incurred for

the reinsurance program.

(B) COMPARATIVE REPORT.--NO LATER THAN 60 DAYS AFTER

INDIVIDUAL MARKET HEALTH INSURANCE RATES ARE FINAL, THE

DEPARTMENT SHALL PREPARE A REPORT SUMMARIZING THE QUANTIFIABLE

IMPACT OF THE REINSURANCE PROGRAM ON INDIVIDUAL MARKET HEALTH

INSURANCE RATES FOR THE FOLLOWING PLAN YEAR.

(b) (C) Distribution of report REPORTS .--The department

20190HB0003PN2211 - 33 -

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shall:

(1) Electronically transmit the report under subsection

(a) to: REPORTS UNDER THIS SECTION TO:

(i) The President pro tempore of the Senate.

(ii) The Minority Leader of the Senate.

(iii) The Speaker of the House of Representatives.

(iv) The Minority Leader of the House of

Representatives.

(v) The chair and minority chair of the

Appropriations Committee of the Senate and the chair and

minority chair of the Appropriations Committee of the

House of Representatives.

(vi) The chair and minority chair of the Banking and

Insurance Committee of the Senate and the chair and

minority chair of the Insurance Committee of the House of

Representatives.

(2) Post the report under subsection (a) REPORTS UNDER

THIS SECTION on the department's publicly accessible Internet

website.

§ 9510. Reinsurance Fund.

(a) Establishment and administration of Reinsurance Fund.--

The Reinsurance Fund is established as a special fund within the

State Treasury. The Reinsurance Fund shall be administered by

the department for the purposes set forth in this chapter,

including the deposit of Federal money and all other money

received pursuant to and disbursements permitted by this

chapter.

(b) Exclusive purpose.--The Reinsurance Fund shall be

dedicated exclusively for the reinsurance program established

under section 9502(b) (relating to implementation of waiver and

20190HB0003PN2211 - 34 -

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establishment of reinsurance program).

(1) Expenditures from the Reinsurance Fund shall be used

to:

(i) Implement and operate the reinsurance program.

(ii) Make reinsurance payments to eligible insurers

under the reinsurance program. Payments to insurers shall

be calculated and made on a pro rata basis.

(2) In making expenditures from the Reinsurance Fund,

available Federal money must be expended first.

(3) Pending disbursement, money in the Reinsurance Fund

shall be invested or reinvested in the same manner as money

in the custody of the State Treasurer. All earnings received

from the investment or reinvestment of money shall be

credited to the Reinsurance Fund.

(d) Expenses.--All costs and expenses of the reinsurance

program shall be paid from the Reinsurance Fund, including

compensation of employees and any independent contractors or

consultants hired by the department.

(e) Nonlapsing and revolving fund.--The following apply:

(1) The Reinsurance Fund shall be a nonlapsing fund. All

money placed in the Reinsurance Fund and interest accrued are

appropriated to the department for expenditure consistent

with the provisions of this chapter.

(2) Nothing in this section shall prevent money in the

Reinsurance Fund from being used as a revolving fund to cover

necessary expenditures if Federal money is requested and

committed but not yet received or if other money is committed

but not yet received.

(f) Limitations.--The following limitations apply:

20190HB0003PN2211 - 35 -

(1) In each fiscal year, the total amount of annual

expenditures from the Reinsurance Fund, including

administrative and consulting expenses, may not exceed the

amount of expected Federal and other money budgeted for

deposit in the Reinsurance Fund in that fiscal year.

(2) Notwithstanding any general or specific powers

granted to the department under this chapter, whether express

or implied, the department may not pledge, in favor of the

reinsurance program, the credit or taxing power of the

Commonwealth or any political subdivision.

§ 9511. Procurements within one year.

Notwithstanding any other provision of law and for the

limited purpose of fulfilling the requirements under this

chapter, procurement of contracts and agreements for the

implementation and operation of the reinsurance program

initiated within one year of the effective date of this section

shall not be subject to the provisions of 62 Pa.C.S. (relating

to procurement). No contract or agreement entered into under

this section may exceed a term of five years.

§ 9512. Access to information and records.

(a) Reports and access.--An insurer shall, without charge,

report information and provide access to and furnish records as

the department requests in order for the department to:

(1) Prepare the State innovation waiver application

submitted under section 9501(a) (relating to application).

(2) Determine reinsurance parameters under section 9504

(relating to reinsurance parameters).

(3) Determine the reinsurance payments due to each

insurer.

(4) Monitor costs and revenues associated with the

20190HB0003PN2211 - 36 -

reinsurance program.

(5) Administer the reinsurance program.

(6) Assure compliance with applicable Federal and State

law.

(b) Time period.--The information and records requested

under subsection (a) shall be provided to the department within

30 days of receipt by an insurer of the written request, unless

required at an earlier date for department compliance with a

request from a Federal or other State agency.

under subsection (a) may only be used for the purposes specified

in subsection (a).

(d) Exemptions.--Any instructions, forms or reports issued

by the department and required to be completed by an insurer

under this section shall not be subject to:

(1) The act of July 31, 1968 (P.L.769, No.240), referred

to as the Commonwealth Documents Law.

(2) The act of October 15, 1980 (P.L.950, No.164), known

as the Commonwealth Attorneys Act.

(3) The act of June 25, 1982 (P.L.633, No.181), known as

the Regulatory Review Act.

§ 9513. Confidentiality and information disclosure.

(a) General rule.--Except as provided for in this section,

a ll working papers, recorded information, documents and copies

of working papers, recorded information and documents produced

by, obtained by or disclosed to the department or any other

person in the course of exercising the department's powers and

duties under this chapter:

(1) shall be confidential;

(2) shall not be subject to subpoena;

20190HB0003PN2211 - 37 -

(3) shall not be subject to the act of February 14, 2008

(P.L.6, No.3), known as the Right-to-Know Law;

(4) shall not be subject to discovery or admissible in

evidence in any private civil action; and

(5) may not be made public by the department or any

other person.

(b) Personal health and financial information.--The

department shall protect personally identifiable health and

financial information in accordance with Federal and State laws

and regulations, including the Health Insurance Portability and

Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936),

the Health Information Technology for Economic and Clinical

Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and

implementing regulations.

provisions of this section:

(1) Information shall be shared as follows:

(i) Between the department and the Centers for

Medicare and Medicaid Services for purposes of compliance

with the Federal acts.

(ii) Between the department and each insurer

participating in the reinsurance program.

(iii) Between the department and the exchange

authority.

(2) Information may be disclosed as follows:

(i) As necessary to comply with the audit

requirements of section 9508 (relating to annual audit)

and the reporting requirements of section 9509 (relating

to annual report of operations), only in an aggregated

and de-identified form.

20190HB0003PN2211 - 38 -

(ii) In any circumstance other than as described in

paragraph (1) or subparagraph (i), only if the prior

written consent of the company or person to which the

information pertains is obtained.

(d) Construction.--Nothing in this section shall be

construed to prohibit the department from accessing the

information reasonably required to carry out its

responsibilities in accordance with law.

§ 9514. Immunity.

(a) General rule.--Except as provided in subsection (b), the

department, a Commonwealth agency or person or entity under

contract with the department for the reinsurance program, or an

authorized representative, agent or employee of any of them may

not be subject to civil or criminal liability and no cause of

action of any nature shall arise for any action taken or not

taken, including any discretionary decision or failure to make a

discretionary decision, when the action or inaction is done in

good faith and in the performance of the powers and duties under

this chapter, or for the reasonable and good faith use of any

information pertaining to the reinsurance program.

(b) Exception.--This section shall not prohibit legal

actions against the reinsurance program to enforce the

reinsurance program's statutory or contractual duties or

obligations.

§ 9515. Regulation of insurers.

Nothing in this chapter shall be construed to limit or

supersede the regulatory authority vested with the department to

regulate the business of insurance within this Commonwealth,

including health insurance policies offered on or off the

exchange.

20190HB0003PN2211 - 39 -

§ 9516. Expiration.

Upon publication of the notice under section 9703(b)

(relating to action by commissioner), the department shall

initiate steps to cease operation of the reinsurance program and

shall cease operation of the reinsurance program no later than

15 months after publication of the notice.

CHAPTER 97

MISCELLANEOUS PROVISIONS

Sec.

9701. Regulations.

9702. Enforcement.

9703. Action by commissioner.

§ 9701. Regulations.

(a) Authority to promulgate.--The department and the

exchange authority may promulgate regulations as may be

necessary and appropriate to carry out the provisions of this

part.

(b) Temporary regulations.--The following apply:

(1) Notwithstanding any other provision of law, in order

to facilitate the prompt implementation of this part, the

department and the exchange authority may issue temporary

regulations which shall expire no later than two years

following publication of the temporary regulations in the

Pennsylvania Bulletin. The temporary regulations shall be

exempt from the following:

(i) Sections 201, 202, 203, 204 and 205 of the act

of July 31, 1968 (P.L.769, No.240), referred to as the

Commonwealth Documents Law.

(ii) Sections 204(b) and 310(10) of the act of

October 15, 1980 (P.L.950, No.164), known as the

20190HB0003PN2211 - 40 -

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Commonwealth Attorneys Act.

(iii) The act of June 25, 1982 (P.L.633, No.181),

known as the Regulatory Review Act.

(2) The authority of the department and the exchange

authority to issue temporary regulations under this

subsection shall expire two years from the effective date of

this section. Regulations adopted after the two-year period

shall be promulgated as provided by statute.

(B) OMISSION OF PROPOSED RULEMAKING.--THE GENERAL ASSEMBLY

FINDS AND DECLARES AS FOLLOWS:

(1) THIS PART IS ESSENTIAL TO:

(I) THE PROVISION OF HEALTH CARE FOR THE CITIZENS OF

THIS COMMONWEALTH; AND

(II) THE FINANCIAL VIABILITY OF THE HEALTH CARE

SYSTEM IN THIS COMMONWEALTH.

(2) THE FINDING AND DECLARATION UNDER PARAGRAPH (1)

CONSTITUTES GOOD CAUSE FOR THE OMISSION OF NOTICE OF PROPOSED

RULEMAKING UNDER SECTION 204(3) OF THE ACT OF JULY 31, 1968

(P.L.769, NO.240), REFERRED TO AS THE COMMONWEALTH DOCUMENTS

LAW.

§ 9702. Enforcement.

(a) General rule.--Upon satisfactory evidence of a violation

of this part by an insurer or other person, one or more of the

following penalties may be imposed at the commissioner's

discretion:

(1) Suspension or revocation of the license of the

insurer or other person.

(2) Refusal, for a period not to exceed one year, to

issue a new license to the insurer or other person.

(3) A fine of not more than $5,000 for each violation.

20190HB0003PN2211 - 41 -

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(4) A fine of not more than $10,000 for each willful

violation.

(b) Limitation.--

(1) Fines imposed against an individual insurer under

this part may not exceed $500,000 in the aggregate during a

single calendar year.

(2) Fines imposed against any other person under this

part may not exceed $100,000 in the aggregate during a single

calendar year.

under this subsection are in addition to any other remedies or

penalties that may be imposed under any other applicable law of

this Commonwealth, including:

(1) The act of July 22, 1974 (P.L.589, No.205), known as

the Unfair Insurance Practices Act. Violations of this part

shall be deemed to be an unfair method of competition and an

unfair or deceptive act or practice under the Unfair

Insurance Practices Act.

(2) The act of June 25, 1997 (P.L.295, No.29), known as

the Pennsylvania Health Care Insurance Portability Act.

(d) Administrative procedure.--The administrative provisions

of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A

(relating to practice and procedure of Commonwealth agencies). A

party against whom penalties are assessed in an administrative

action may appeal to Commonwealth Court as provided in 2 Pa.C.S.

Ch. 7 Subch. A (relating to judicial review of Commonwealth

agency action).

§ 9703. Action by commissioner.

(a) Sunset.--This a ct PART shall sunset immediately if any

of the following occur:

20190HB0003PN2211 - 42 -

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(1) The Congress of the United States repeals or

defunds , in whole or in part, THOSE PROVISIONS OF the

Affordable Care Act in a manner that renders impossible to

perform the duties of INTEGRAL TO the exchange authority

established under Chapter 93 (relating to State-based

Exchange) or the reinsurance program established under

Chapter 95 (relating to reinsurance program).

(2) A court of the United States with competent

jurisdiction invalidates , in whole or in part, THE PROVISIONS

OF the Affordable Care Act in a manner that renders

impossible to perform INTEGRAL TO the duties of the exchange

authority established under Chapter 93 or the reinsurance

program established under Chapter 95.

(3) The Executive Branch of the United States repeals or

defunds , in whole or in part, THE PROVISIONS OF the

Affordable Care Act and its subsequent regulations in a

manner that renders impossible to perform INTEGRAL TO the

duties of the exchange authority established under Chapter 93

or the reinsurance program established under Chapter 95.

(b) Notice.--If this part sunsets pursuant to subsection

(a), the commissioner shall transmit notice of that action to

the Legislative Reference Bureau for publication in the

Pennsylvania Bulletin.

Section 2. This act shall take effect immediately.

20190HB0003PN2211 - 43 -

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