PRINTER'S NO. 2071
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1828
Session of
2021
INTRODUCED BY KOSIEROWSKI, BENHAM, FRANKEL, HOHENSTEIN,
ISAACSON, SANCHEZ, A. DAVIS, BRADFORD, INNAMORATO, SIMS,
MADDEN, SCHLOSSBERG AND CIRESI, SEPTEMBER 1, 2021
REFERRED TO COMMITTEE ON HEALTH, SEPTEMBER 1, 2021
AN ACT
Amending the act of April 9, 1929 (P.L.177, No.175), entitled
"An act providing for and reorganizing the conduct of the
executive and administrative work of the Commonwealth by the
Executive Department thereof and the administrative
departments, boards, commissions, and officers thereof,
including the boards of trustees of State Normal Schools, or
Teachers Colleges; abolishing, creating, reorganizing or
authorizing the reorganization of certain administrative
departments, boards, and commissions; defining the powers and
duties of the Governor and other executive and administrative
officers, and of the several administrative departments,
boards, commissions, and officers; fixing the salaries of the
Governor, Lieutenant Governor, and certain other executive
and administrative officers; providing for the appointment of
certain administrative officers, and of all deputies and
other assistants and employes in certain departments, boards,
and commissions; providing for judicial administration; and
prescribing the manner in which the number and compensation
of the deputies and all other assistants and employes of
certain departments, boards and commissions shall be
determined," providing for Office of Health Care Consumer
Advocate; imposing duties on the Office of Attorney General;
and making appropriations.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of April 9, 1929 (P.L.177, No.175), known
as The Administrative Code of 1929, is amended by adding an
article to read:
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ARTICLE IX-C
OFFICE OF HEALTH CARE CONSUMER ADVOCATE
Section 901-C. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commonwealth agency." Any of the following:
(1) The Department of Health.
(2) The Department of Human Services.
(3) The Insurance Department.
(4) An y other department, board, office, commission or
agency under the jurisdiction of the Governor that provides
assistance or information related to health care or health
insurance to consumers or collects data and recommendations
for improving medical services and health care in this
Commonwealth.
"Health care." Any medical service, including the following:
(1) B ehavioral health and mental health.
(2) M aternal health.
(3) Substance use disorder treatment, including
medication assisted treatment.
(4) Preventive health care.
(5) Pharmacy and pharmaceutical services.
(6) Diagnostic testing and laboratory services.
(7) Medical devices and equipment.
"Health care consumer." An individual or the parent,
guardian, conservator or authorized representative of the
individual who is:
(1) a resident of this Commonwealth, regardless of age;
and
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(2) seeking or has received a medical service.
"Health care consumer advocate." The director of the Office
of Health Care Consumer Advocate appointed in accordance with
section 902-C.
"Health care facility." As defined in section 103 of the act
of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Health care provider." As defined in section 103 of the
Health Care Facilities Act.
"Health insurance." A group health, sickness or accident
policy or subscriber contract or certificate issued by an entity
subject to any one of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
" Health maintenance organization." As defined in section 3
of the Health Maintenance Organization Act.
"Individual." A natural person who is a resident of this
Commonwealth, regardless of age, immigration status, criminal
record, housing status or other circumstance of life.
"Insurer." An entity subject to any of the following:
(1) T he Insurance Company Law of 1921, including section
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630 and Article XXIV of that act.
(2) The Health Maintenance Organization Act.
(3) The Individual Accident and Sickness Insurance
Minimum Standards Act.
(4) 40 Pa.C.S. Ch. 61 or 63.
"Managed care organization." As defined in section 501-A of
t he act of June 13, 1967 (P.L.31, No.21), known as the Human
Services Code.
"Managed care plan." As defined in section 2102 of The
Insurance Company Law of 1921.
"Medical service." As defined in section 2 of the act of
December 20, 1985 (P.L.457, No.112), known as the Medical
Practice Act of 1985.
"Office." The Office of Health Care Consumer Advocate
established under section 902-C.
Section 902-C. Office of Health Care Consumer Advocate.
(a) Establishment.--The Office of Health Care Consumer
Advocate is established within the Office of Attorney General.
(b) Purposes.--The purpose of the office is to:
(1) Provide assistance to, and advocate on behalf of,
health care consumers in this Commonwealth.
(2) E nhance the consumer protection role of the Office
of Attorney General to:
(i) Protect the health, safety and general welfare
of health care consumers in this Commonwealth.
(ii) Ensure equity in the delivery of quality and
affordable health care to all health care consumers in
this Commonwealth.
(3) Coordinate among, provide assistance to and collect
data from all health care or patient assistance programs and
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consumer call or help centers administered or operated by
Commonwealth agencies to better enable health care consumers
to access the following:
(i) Health care.
(ii) Commercial health insurance.
(iii) The Commonwealth's State-based insurance
marketplace (Pennie).
(iv) Medical assistance under the act of June 13,
1967 (P.L.31, No.21), known as the Human Services Code.
(v) Federal veterans' health benefits.
Section 903-C. Office staff.
(a) Health care consumer advocate.--
(1) The Attorney General shall appoint the health care
consumer advocate, who shall be:
(i) A deputy attorney general.
(ii) By reason of training, experience and
professional expertise, qualified to represent the health
care interests of health care consumers in this
Commonwealth.
(2) The term of the health care consumer advocate shall
be for six years.
(3) An individual may be reappointed to serve subsequent
terms as a health care consumer advocate as determined by the
Attorney General.
(4) The health care consumer advocate may not:
(i) Engage in any business, vocation or other
employment, or have other interests, inconsistent with
the official responsibilities of the office.
(ii) Seek or accept employment with, or render
beneficial services for compensation to, a health care
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provider or insurer for a period of two years from the
date that the appointment as health care consumer
advocate expires or the term of office as health care
consumer advocate is terminated.
(iii) Seek election or accept appointment to a
political office during the tenure as health care
consumer advocate and for a period of two years from the
date that the appointment as health care consumer
advocate expires or the term of office as health care
consumer advocate is terminated.
(b) Assistant health care consumer advocates and other
employees.--
(1) I n consultation with the Attorney General, t he
health care consumer advocate shall:
(i) Appoint attorneys as assistant health care
consumer advocates and employ other individuals,
including administrative, support, technical and
professional staff, as may be necessary to carry out the
powers and duties of the office.
(ii) Contract for additional services as may be
necessary to carry out the powers and duties of the
office.
(2) The employees of the office shall be considered
State employees for purposes of 71 Pa.C.S. Pt. XXV (relating
to retirement for State employees and officers).
(3) An assistant health care consumer advocate or other
employee of the office may not, while serving in the
position, engage in any business, vocation or other
employment or have other interests inconsistent with the
duties and responsibilities of employment of the assistant
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health care consumer advocate or employee.
(4) Assistant health care consumer advocates and other
employees of the office shall reflect the diverse racial,
ethnic, gender, age, sexual orientation, religious and
disability demographics of this Commonwealth.
Section 904-C. Powers and duties of office.
T he office, at the direction of the health care consumer
advocate, shall:
(1) Review complaints received by the office related to
the delivery of health care and health insurance benefits and
conduct any investigations necessary to assure quality and
affordable health care, including the delivery of
geographically, culturally and linguistically appropriate
health care, for all residents of this Commonwealth.
(2) Appear as an amicus curiae in proceedings involving
any of the following:
(i) A health care quality standard or issue.
(ii) Complaints alleging negligence in the delivery
of health care.
(iii) Complaints alleging denial of health insurance
benefits or unfair insurance practices.
(iv) Any other complaint, allegation or matter
related to the delivery of or access to health care or
health insurance benefits.
(3) Intervene in or request initiation of an
administrative action by the Commonwealth or a Commonwealth
agency related to the delivery of health care or health
insurance benefits.
(4) Assist and cooperate with any Commonwealth agency in
the investigation of complaints, occurrences, conditions or
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practices with respect to inadequacies or inequities in the
delivery of health care, health insurance or covered
benefits.
(5) Assist health care consumers with managed care plan
selection by providing information, referral and assistance
related to obtaining health insurance coverage and benefits.
(6) Assist health care consumers with the filing of
complaints, grievances and appeals, including filing appeals
with a managed care organization's internal appeal or
grievance process and any external appeal process that may be
available to a health care consumer.
(7) Ensure that health care consumers have timely access
to the services provided by the office.
(8) Pursue administrative remedies on behalf of and with
the consent of any health care consumer.
(9) Analyze and monitor the development and
implementation of Federal, State and local laws, regulations
and policies relating to the delivery of health care and
health insurance and recommend legislative or regulatory
changes where appropriate.
(10) Facilitate public comment on laws, regulations and
policies or proposed laws, regulations and policies,
including any law, regulation or policy impacting the
availability and affordability of health care and health
insurance, by convening public hearings, webinars, forums and
town halls.
(11) When appropriate, refer health care consumers to
the appropriate Commonwealth agency for filing complaints or
grievances and to protect the interests of health care
consumers.
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(12) In consultation with the Insurance Department,
compile a list of complaints received against insurers. The
following apply:
(i) The list may be maintained jointly by the office
and the Insurance Department.
(ii) Notwithstanding any other provision of law, the
names and any other personal identifying information
compiled and maintained on the list in accordance with
this paragraph shall be confidential and shall not be
subject to disclosure under the act of February 14, 2008
(P.L.6, No.3), known as the Right-to-Know Law.
(13) In consultation with the Department of State, or
with the appropriate licensing boards under the jurisdiction
of the Department of State, compile a list of complaints
received against health care providers. The following apply:
(i) The list may be maintained jointly by the office
and the Department of State or the appropriate licensing
board.
(ii) Notwithstanding any other provision of law, the
names and any other personal identifying information
compiled and maintained on the list in accordance with
this paragraph shall be confidential and shall not be
subject to disclosure under the Right-to-Know Law.
(14) In consultation with the Department of Health,
compile a list of complaints received against health care
facilities. The following apply:
(i) The list may be maintained jointly by the office
and the Department of Health.
(ii) Notwithstanding any other provision of law, the
names and any other personal identifying information
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compiled and maintained on the list in accordance with
this paragraph shall be confidential and shall not be
subject to disclosure under the Right-to-Know Law.
(15) In consultation with the Department of Human
Services, compile a list of complaints received against
health care providers, insurers, health maintenance
organizations or any other for-profit or nonprofit entity
that provides medical services to medical assistance
recipients or that receives payments for such services in
accordance with the act of June 13, 1967 (P.L.31, No.21),
known as the Human Services Code. The following apply:
(i) The list may be maintained jointly by the office
and the Department of Human Services.
(ii) Notwithstanding any other provision of law, the
names and any other personal identifying information
compiled and maintained on the list in accordance with
this paragraph shall be confidential and shall not be
subject to disclosure under the Right-to-Know Law.
(16) In consultation with the Department of Health, the
Department of Human Services and the Insurance Department,
establish health care consumer assistance help centers or
call centers or utilize existing help centers or call centers
operated by the Department of Health, the Department of Human
Services or the Insurance Department, for use by health care
consumers to obtain information or file or report complaints
related to the delivery of health care or health insurance
coverage. The office shall collaborate with the Department of
Health, the Department of Human Services and the Insurance
Department to develop model protocols to govern how the help
centers or call centers respond to:
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(i) Requests for information.
(ii) The acceptance and filing of health care
consumer complaints.
(iii) Health care consumer inquiries, including
inquiries that may be outside the jurisdiction of the
office.
(17) Contract and execute instruments as necessary to
carry out the powers and duties of the office.
(18) Take any other actions necessary to administer and
enforce the provisions of this article, including:
(i) Collecting, tracking and analyzing data on
problems and complaints by, and questions from, health
care consumers about health care coverage for the purpose
of providing public information about problems
encountered and information needed by health care
consumers in accessing health care and health insurance.
The data collected shall include:
(A) Demographic data.
(B) The source or sources of health insurance
coverage.
(C) Identification of the regulatory agency.
(D) The nature of complaints, problems or issues
or comparable types of complaints, problems or
issues.
(E) The resolution of complaints, problems or
issues, including the timeliness of resolution.
(ii) Providing geographically, culturally and
linguistically appropriate public education.
(iii) I nstituting legal action, to secure and ensure
compliance with the provisions of the health care and
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health insurance laws and regulations of this
Commonwealth.
(iv) Advocating for any administrative or
legislative changes determined necessary to support the
goal of quality and affordable health care, including the
delivery of geographically, culturally and linguistically
appropriate health care, for all residents in this
Commonwealth.
(19) Within six months after the effective date of this
paragraph, in a manner that does not impede the immediate
implementation of the powers and duties of the office under
this article and in consultation with the Attorney General,
develop an inclusion and participation plan to ensure that:
(i) All health care consumers are accorded equity in
securing relief under this article.
(ii) All persons are accorded equality of
opportunity in employment and contracting by the office
and its contractors, subcontractors, assignees, lessees,
agents, vendors and suppliers.
(20) Develop a publicly accessible Internet website
configured to be easily navigated by health care consumers to
retrieve public information related to the delivery of health
care and health insurance. The office shall, to the extent
feasible, ensure that the information posted on its publicly
accessible Internet website can be translated into other
languages spoken by residents of this Commonwealth who speak
English as a second language, including Spanish.
(21) Submit reports and recommendations, in addition to
the annual report under section 905-C, as necessary or
desirable to carry out the purposes, powers and duties of the
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office.
Section 905-C. Reports.
(a) Requirement.--The health care consumer advocate shall
submit an annual report to:
(1) The Governor.
(2) The majority chairperson and minority chairperson of
the Banking and Insurance Committee of the Senate.
(3) The majority chairperson and minority chairperson of
the Health and Human Services Committee of the Senate.
(4) The majority chairperson and minority chairperson of
the Health Committee of the House of Representatives.
(5) The majority chairperson and minority chairperson of
the Human Services Committee of the House of Representatives.
(6) The majority chairperson and minority chairperson of
the Insurance Committee of the House of Representatives.
(b) Contents.--A report under subsection (a) shall summarize
the activities of the health care consumer advocate and the
office for the preceding calendar year and shall include
information and metrics regarding:
(1) Activities of the health care consumer advocate,
including:
(i) Case volume, including the type and nature of
complaints related to access to health care and health
insurance.
(ii) Stakeholder surveys and survey results.
(iii) Outreach and education activities.
(iv) Participation on committees and working groups,
along with legislative recommendations and outcomes.
(2) The subject, disposition and number of complaints,
investigations, mediations, appeals and other administrative
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or legal actions.
(3) Problems and concerns discerned by the office from
the complaints, investigations, mediations, appeals and legal
actions, if any.
(4) The need, if any, for administrative, legislative or
regulatory remedies for inadequacies or inequities in the
delivery of health care or access to health care insurance.
(5) Quantitative and qualitative documentation of health
care outcomes, including:
(i) The number of individuals with and without
health care insurance, rural and urban access to health
care providers and health care facilities.
(ii) Appeal success rate.
(iii) Financial returns to individuals and the
Commonwealth.
(iv) Testimonies from health care consumers, health
care workers, residents and stakeholders related to the
delivery of health care and access to health insurance.
(c) Format.--To the extent feasible, a report under
subsection (a) shall be disaggregated by income level, race and
ethnicity, immigration and citizenship status, health care
insurance status, type of health insurance, health insurance
premium rates, if known, county of residence and other relevant
demographic information as determined appropriate by the health
care consumer advocate to ensure equity.
(d) Publication.-- The office shall:
(1) Submit each report under subsection (a) to the
Legislative Reference Bureau for publication in the
Pennsylvania Bulletin.
(2) Post the report on the publicly accessible Internet
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website of the office.
Section 906-C. Request for information.
The health care consumer advocate shall respond promptly to
reasonable requests for information from the Governor, the
General Assembly and Commonwealth agencies.
Section 907-C. Health care information.
(a) Authorization.--Notwithstanding any other provision of
law, the office shall be entitled to receive confidential health
care information available to the Commonwealth agencies.
(b) Restrictions.--Confidential health care information
received by the office under this section may not:
(1) Be disclosed by the health care consumer advocate,
an employee of the office or any other person, except
pursuant to judicial process.
(2) Be used against the subject of the information or
any other person in any administrative, civil or criminal
proceeding or in any other matter.
(3) Include the name, address or Social Security number
of the subject of the information or any information that
specifically identifies the subject of the information.
(c) Disposition of records.--Upon the completion of an
investigation, administrative or legal action initiated or
conducted under this article, all records obtained by the office
under this section shall be destroyed.
Section 908-C. Commonwealth agency cooperation.
Notwithstanding any other law to the contrary, each
Commonwealth agency shall cooperate with the office in carrying
out the powers and duties under this article, including the
furnishing of data and information related to the delivery of
health care and health insurance coverage.
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Section 909-C. Liability.
(a) Immunity.--
(1) Notwithstanding any other provision of law, a cause
of action shall not arise and liability shall not be imposed
against the health care consumer advocate, an employee of the
office, a health care provider or insurer, an employee of a
health care provider or insurer or any other person subject
to the provisions of this article for any statement made,
investigation conducted or activity performed in good faith
in accordance with the provisions of this article, unless the
lack of good faith is demonstrated by clear and convincing
evidence.
( 2) A cause of action shall not arise and liability
shall not be imposed against a person identified in paragraph
(1) for the act of communicating or delivering information or
data to the health care consumer advocate, the Attorney
General or an employee of the office or the Office of
Attorney General pursuant to an investigation conducted under
this article if the act of communication or delivery was
performed in good faith and without fraudulent intent or the
intent to deceive.
(b) Other privileges and immunities.--This section shall not
abrogate or modify in any way any common law or statutory
privilege or immunity established prior to the effective date of
this subsection.
(c) Good faith.-- The presumption of good faith may be
rebutted by clear and convincing evidence establishing that a
person subject to the provisions of this article disclosed
information that:
(1) the person knew was false or, in the exercise of due
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diligence, should have known was false;
(2) the person knew was materially misleading;
(3) was false and rendered with reckless disregard as to
the truth or falsity of the information; or
(4) was prohibited from disclosure under Federal or
State law.
(d) Effect on immunity.--This section shall not be construed
to affect immunities from civil liability or defenses
established under any other law or available at common law to
which a person identified in subsection (a) may be entitled.
Section 910-C. Regulations, guidelines or policy statements.
The office may adopt and promulgate regulations, guidelines
or policy statements to carry out the provisions of this
article.
Section 911-C. Appropriations.
Notwithstanding Subarticle A of Article XVII-A of the act of
April 9, 1929 (P.L.343, No.176), known as The Fiscal Code, or
any other provision of law, for the fiscal year beginning July
1, 2021, and ending June 30, 2022, and for each fiscal year
thereafter, the sum of $10,000,000, or as much thereof as may be
necessary, is hereby appropriated to the Attorney General from
the Budget Stabilization Reserve Fund to implement and
administer the provisions of this article.
Section 912-C. Construction.
No provision of this article shall be construed to:
(1) Limit the right of a health care consumer to bring a
proceeding before another Commonwealth agency or a court with
jurisdiction.
(2) Abrogate or otherwise limit the authority of another
Commonwealth agency, including the authority to resolve
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consumer complaints, grievances and appeals.
Section 2. This act shall take effect in 60 days.
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