S1137B1621A06050 VDL:JB 03/10/08 #90 A06050
AMENDMENTS TO SENATE BILL NO. 1137
Sponsor: REPRESENTATIVE WATSON
Printer's No. 1621
1 Amend Title, page 2, line 2, by striking out all of said line
2 and inserting
3 procedure, for certificate of retention, for the Health Care
4 Provider Retention Account and for expiration and providing for
5 the Health Care Provider Retention Reserve Account; providing
6 for small business health savings tax account tax credits, for
7 disease management tax credits, for healthy living and wellness
8 tax incentives, for community-based health provider assistance
9 and for health care comparison; and making a transfer.
10 Amend Bill, page 2, lines 9 through 30; pages 3 through 12,
11 lines 1 through 30; page 13, lines 1 through 27, by striking out
12 all of said lines on said pages and inserting
13 Section 1. Sections 711(d) and 712(c), (e) and (m) of the
14 act of March 20, 2002 (P.L.154, No.13), known as the Medical
15 Care Availability and Reduction of Error (Mcare) Act, are
16 amended to read:
17 Section 711. Medical professional liability insurance.
18 * * *
19 (d) Basic coverage limits.--A health care provider shall
20 insure or self-insure medical professional liability in
21 accordance with the following:
22 (1) For policies issued or renewed in the calendar year
23 2002, the basic insurance coverage shall be:
24 (i) $500,000 per occurrence or claim and $1,500,000
25 per annual aggregate for a health care provider who
26 conducts more than 50% of its health care business or
27 practice within this Commonwealth and that is not a
28 hospital.
29 (ii) $500,000 per occurrence or claim and $1,500,000
30 per annual aggregate for a health care provider who
31 conducts 50% or less of its health care business or
32 practice within this Commonwealth.
33 (iii) $500,000 per occurrence or claim and
34 $2,500,000 per annual aggregate for a hospital.
35 (2) For policies issued or renewed in the calendar years
36 2003, 2004 [and 2005], 2005, 2006 and 2007, the basic
37 insurance coverage shall be:
38 (i) $500,000 per occurrence or claim and $1,500,000
1 per annual aggregate for a participating health care 2 provider that is not a hospital. 3 (ii) $1,000,000 per occurrence or claim and 4 $3,000,000 per annual aggregate for a nonparticipating 5 health care provider. 6 (iii) $500,000 per occurrence or claim and 7 $2,500,000 per annual aggregate for a hospital. 8 (3) [Unless the commissioner finds pursuant to section 9 745(a) that additional basic insurance coverage capacity is 10 not available, for] For policies issued or renewed in 11 calendar year [2006 and each year thereafter subject to 12 paragraph (4)] 2008, the basic insurance coverage shall be: 13 (i) [$750,000] $550,000 per occurrence or claim and 14 $2,250,000 per annual aggregate for a participating 15 health care provider that is not a hospital. 16 (ii) $1,000,000 per occurrence or claim and 17 $3,000,000 per annual aggregate for a nonparticipating 18 health care provider. 19 (iii) [$750,000] $550,000 per occurrence or claim 20 and $3,750,000 per annual aggregate for a hospital. 21 [If the commissioner finds pursuant to section 745(a) that 22 additional basic insurance coverage capacity is not 23 available, the basic insurance coverage requirements shall 24 remain at the level required by paragraph (2); and the 25 commissioner shall conduct a study every two years until the 26 commissioner finds that additional basic insurance coverage 27 capacity is available, at which time the commissioner shall 28 increase the required basic insurance coverage in accordance 29 with this paragraph.] 30 (4) [Unless the commissioner finds pursuant to section 31 745(b) that additional basic insurance coverage capacity is 32 not available, for] For policies issued or renewed [three 33 years after the increase in coverage limits required by 34 paragraph (3)] in calendar year 2009 and for each year 35 thereafter, the basic insurance coverage shall be: 36 (i) [$1,000,000] $600,000 per occurrence or claim 37 and $3,000,000 per annual aggregate for a participating 38 health care provider that is not a hospital. 39 (ii) $1,000,000 per occurrence or claim and 40 $3,000,000 per annual aggregate for a nonparticipating 41 health care provider. 42 (iii) [$1,000,000] $600,000 per occurrence or claim 43 and $4,500,000 per annual aggregate for a hospital. 44 [If the commissioner finds pursuant to section 745(b) that 45 additional basic insurance coverage capacity is not 46 available, the basic insurance coverage requirements shall 47 remain at the level required by paragraph (3); and the 48 commissioner shall conduct a study every two years until the 49 commissioner finds that additional basic insurance coverage 50 capacity is available, at which time the commissioner shall 51 increase the required basic insurance coverage in accordance 52 with this paragraph.] 53 (5) For policies issued or renewed in calendar year 2010 54 and each year thereafter, the commissioner shall increase the 55 required per occurrence or claim basic insurance coverage by 56 $50,000 increments for a participating health care provider 57 that is not a hospital and for a hospital until such time as 58 the required per occurrence or claim basic insurance coverage 59 is $750,000. SB1137A06050 - 2 -
1 (6) For policies issued or renewed in the calendar year 2 immediately following the calendar year in which the required 3 per occurrence or claim basic insurance coverage is $750,000 4 and each year thereafter, the basic insurance coverage shall 5 be: 6 (i) $1,000,000 per occurrence or claim and 7 $3,000,000 per annual aggregate for a participating 8 health care provider that is not a hospital. 9 (ii) $1,000,000 per occurrence or claim and 10 $3,000,000 per annual aggregate for a nonparticipating 11 health care provider. 12 (iii) $1,000,000 per occurrence or claim and 13 $4,500,000 per annual aggregate for a hospital. 14 * * * 15 Section 712. Medical Care Availability and Reduction of Error 16 Fund. 17 * * * 18 (c) Fund liability limits.-- 19 (1) For calendar year 2002, the limit of liability of 20 the fund created in section 701(d) of the former Health Care 21 Services Malpractice Act for each health care provider that 22 conducts more than 50% of its health care business or 23 practice within this Commonwealth and for each hospital shall 24 be $700,000 for each occurrence and $2,100,000 per annual 25 aggregate. 26 (2) The limit of liability of the fund for each 27 participating health care provider shall be as follows: 28 (i) For calendar year 2003 and each year thereafter, 29 the limit of liability of the fund shall be $500,000 for 30 each occurrence and $1,500,000 per annual aggregate. 31 (ii) If the basic insurance coverage requirement is 32 increased in accordance with section 711(d)(3), (4) or 33 (5) and, notwithstanding subparagraph (i), for each 34 calendar year following the increase in the basic 35 insurance coverage requirement, the limit of liability of 36 the fund shall be [$250,000 for each occurrence and 37 $750,000 per annual aggregate.] $1,000,000 per occurrence 38 or claim and $3,000,000 per annual aggregate for a health 39 care provider except a hospital or $1,000,000 per 40 occurrence or claim and $4,500,000 per annual aggregate 41 for a hospital, minus the amount required for basic 42 insurance coverage under section 711(d)(3) or (4) or the 43 amount the commissioner determines as the required basic 44 insurance coverage under section 711(d)(5), as 45 appropriate. 46 (iii) If the basic insurance coverage requirement is 47 increased in accordance with section [711(d)(4)] 48 711(d)(6) and, notwithstanding subparagraphs (i) and 49 (ii), for each calendar year following the increase in 50 the basic insurance coverage requirement, the limit of 51 liability of the fund shall be zero. 52 * * * 53 [(e) Discount on surcharges and assessments.-- 54 (1) For calendar year 2002, the department shall 55 discount the aggregate surcharge imposed under section 56 701(e)(1) of the Health Care Services Malpractice Act by 5% 57 of the aggregate surcharge imposed under that section for 58 calendar year 2001 in accordance with the following: 59 (i) Fifty percent of the aggregate discount shall be SB1137A06050 - 3 -
1 granted equally to hospitals and to participating health 2 care providers that were surcharged as members of one of 3 the four highest rate classes of the prevailing primary 4 premium. 5 (ii) Notwithstanding subparagraph (i), 50% of the 6 aggregate discount shall be granted equally to all 7 participating health care providers. 8 (iii) The department shall issue a credit to a 9 participating health care provider who, prior to the 10 effective date of this section, has paid the surcharge 11 imposed under section 701(e)(1) of the former Health Care 12 Services Malpractice Act for calendar year 2002 prior to 13 the effective date of this section. 14 (2) For calendar years 2003 and 2004, the department 15 shall discount the aggregate assessment imposed under 16 subsection (d) for each calendar year by 10% of the aggregate 17 surcharge imposed under section 701(e)(1) of the former 18 Health Care Services Malpractice Act for calendar year 2001 19 in accordance with the following: 20 (i) Fifty percent of the aggregate discount shall be 21 granted equally to hospitals and to participating health 22 care providers that were assessed as members of one of 23 the four highest rate classes of the prevailing primary 24 premium. 25 (ii) Notwithstanding subparagraph (i), 50% of the 26 aggregate discount shall be granted equally to all 27 participating health care providers. 28 (3) For calendar years 2005 and thereafter, if the basic 29 insurance coverage requirement is increased in accordance 30 with section 711(d)(3) or (4), the department may discount 31 the aggregate assessment imposed under subsection (d) by an 32 amount not to exceed the aggregate sum to be deposited in the 33 fund in accordance with subsection (m).] 34 * * * 35 (m) Supplemental funding.--Notwithstanding the provisions of 36 75 Pa.C.S. § 6506(b) (relating to surcharge) to the contrary, 37 beginning January 1, 2004, [and for a period of nine calendar 38 years thereafter,] all surcharges levied and collected under 75 39 Pa.C.S. § 6506(a) by any division of the unified judicial system 40 shall be remitted to the Commonwealth for deposit in the Medical 41 Care Availability and Restriction of Error Fund. These funds 42 shall be used to reduce surcharges and assessments [in 43 accordance with subsection (e). Beginning January 1, 2014, and 44 each year thereafter, the surcharges levied and collected under 45 75 Pa.C.S. § 6506(a) shall be deposited into the General Fund] 46 levied under this section. 47 * * * 48 Section 1.1. The act is amended by adding a section to read: 49 Section 762. Medical Safety Automation Fund established. 50 There is established within the State Treasury a special fund 51 to be known as the Medical Safety Automation Fund. No money in 52 the Medical Safety Automation Fund shall be used until 53 legislation is enacted for the purpose of providing medical 54 safety automation system grants to health care providers under 55 the act of July 19, 1979 (P.L.130, No.48), known as the Health 56 Care Facilities Act, a group practice or a community-based 57 health care provider. 58 Section 2. The definition of "account" in section 1101 of 59 the act, added December 22, 2005 (P.L.458, No.88), is amended to SB1137A06050 - 4 -
1 read: 2 Section 1101. Definitions. 3 The following words and phrases when used in this chapter 4 shall have the meanings given to them in this section unless the 5 context clearly indicates otherwise: 6 "Account." The Health Care Stabilization and Provider 7 Retention Account established in section 1112. 8 * * * 9 Section 3. Section 1102 of the act, amended October 27, 2006 10 (P.L.1198, No.128), is amended to read: 11 Section 1102. Abatement program. 12 (a) Establishment.--There is hereby established within the 13 Insurance Department a program to be known as the Health Care 14 Provider Retention Program. The Insurance Department, in 15 conjunction with the Department of Public Welfare, shall 16 administer the program. The program shall provide assistance in 17 the form of assessment abatements to health care providers for 18 calendar years 2003[, 2004, 2005, 2006 and 2007] and each year 19 thereafter until the liability of the fund under section 20 712(c)(2)(iii) is zero, except that licensed podiatrists shall 21 not be eligible for calendar years 2003 and 2004, and nursing 22 homes shall not be eligible for calendar years 2003, 2004 and 23 2005. 24 (b) Other abatement.--Emergency physicians not employed full 25 time by a trauma center or working under an exclusive contract 26 with a trauma center shall retain eligibility for an abatement 27 pursuant to section 1104(b)(2) for calendar years 2003, 2004, 28 2005 and 2006. Commencing in calendar year 2007, these emergency 29 physicians shall be eligible for an abatement pursuant to 30 section 1104(b)(1). 31 Section 4. Sections 1104, 1105 and 1112 of the act, added 32 December 22, 2005 (P.L.458, No.88), are amended to read: 33 Section 1104. Procedure. 34 (a) Application.--A health care provider may apply to the 35 Insurance Department for an abatement of the assessment imposed 36 for the previous calendar year specified on the application. The 37 application must be submitted by the second Monday of February 38 of the calendar year specified on the application and shall be 39 on the form required by the Insurance Department. The department 40 shall require that the application contain all of the following 41 supporting information: 42 (1) A statement of the applicant's field of practice, 43 including any specialty. 44 (2) Except for physicians enrolled in an approved 45 residency or fellowship program, a signed certificate of 46 retention. 47 (3) A signed certification that the health care provider 48 is an eligible applicant under section 1103 for the program. 49 (4) Such other information as the Insurance Department 50 may require. 51 (a.1) Electronically filed application.--A hospital may 52 submit an electronic application on behalf of all health care 53 providers when the hospital is responsible for payment of the 54 health care provider's assessment under this act and the 55 hospital has received prior written approval from the Insurance 56 Department. 57 (b) Review.--Upon receipt of a completed application, the 58 Insurance Department shall review the applicant's information 59 and grant the applicable abatement of the assessment for the SB1137A06050 - 5 -
1 previous calendar year specified on the application in 2 accordance with all of the following: 3 (1) The Insurance Department shall notify the Department 4 of Public Welfare that the applicant has self-certified as 5 eligible for a 100% abatement of the imposed assessment if 6 the health care provider was assessed under section 712(d) 7 as: 8 (i) a physician who is assessed as a member of one 9 of the four highest rate classes of the prevailing 10 primary premium; 11 (ii) an emergency physician; 12 (iii) a physician who routinely provides obstetrical 13 services in rural areas as designated by the Insurance 14 Department; or 15 (iv) a certified nurse midwife. 16 (2) The Insurance Department shall notify the Department 17 of Public Welfare that the applicant has self-certified as 18 eligible for a 50% abatement of the imposed assessment if the 19 health care provider was assessed under section 712(d) as: 20 (i) a physician but is a physician who does not 21 qualify for abatement under paragraph (1); 22 (ii) a licensed podiatrist; or 23 (iii) a nursing home. 24 (3) Notwithstanding paragraph (2), upon the required 25 basic insurance coverage being increased under section 26 711(d)(3), (4) or (5), the Insurance Department shall 27 annually increase the abatement each applicant is entitled to 28 claim under paragraph (2) by 10%. 29 (c) Refund.--If a health care provider paid the assessment 30 for the calendar year prior to applying for an abatement under 31 subsection (a), the health care provider may, in addition to the 32 completed application required by subsection (a), submit a 33 request for a refund. The request shall be submitted on the form 34 required by the Insurance Department. If the Insurance 35 Department grants the health care provider an abatement of the 36 assessment for the calendar year in accordance with subsection 37 (b), the Insurance Department shall either refund to the health 38 care provider the portion of the assessment which was abated or 39 issue a credit to the health care provider's professional 40 liability insurer. 41 Section 1105. Certificate of retention. 42 (a) Certificate.--The Insurance Department shall prepare a 43 certificate of retention form. The form shall require a health 44 care provider seeking an abatement under the program to attest 45 that the health care provider will continue to provide health 46 care services in this Commonwealth for at least one full 47 calendar year following the year for which an abatement was 48 received pursuant to this chapter. 49 (a.1) Hospital responsibility.--When a hospital has 50 submitted an application on behalf of a health care provider, 51 the hospital shall be responsible for ensuring compliance with 52 the certificate of retention and shall indemnify the health care 53 provider retention account for each health care provider who 54 fails to continue to provide medical services within this 55 Commonwealth for the year following receipt of the abatement. 56 (b) Repayment.-- 57 (1) Except as provided in paragraph (2), if a health 58 care provider receives an abatement but, prior to the end of 59 the retention period, ceases providing health care services SB1137A06050 - 6 -
1 in this Commonwealth, the health care provider shall repay to 2 the Commonwealth 100% of the abatement received plus 3 administrative and legal costs, if applicable. A health care 4 provider subject to this paragraph shall provide written 5 notice to the Insurance Department within 60 days of the date 6 of cessation of health care services. 7 (2) Paragraph (1) shall not apply to a health care 8 provider who is any of the following: 9 (i) A health care provider who is enrolled in an 10 approved residency or fellowship program. 11 (ii) A health care provider who dies prior to the 12 end of the retention period. 13 (iii) A health care provider who is disabled and 14 unable to practice prior to the end of the retention 15 period. 16 (iv) A health care provider who is called to active 17 military duty prior to the end of the retention period. 18 (v) A health care provider who retires and who is at 19 least 70 years of age prior to the end of the retention 20 period. 21 (c) Tax.--An amount owed the Commonwealth under subsection 22 (b) shall be considered a tax under section 1401 of the act of 23 April 9, 1929 (P.L.343, No.176), known as The Fiscal Code. The 24 Department of Revenue shall provide assistance to the Insurance 25 Department in any collection effort. Any amount collected under 26 this chapter, including administrative and legal costs, shall be 27 deposited into the [Health Care Provider Retention Account] 28 account. 29 (d) Failure to pay.--The Insurance Department shall notify 30 the appropriate licensing board of any failure to pay an amount 31 required of a licensee under this section. Upon such 32 notification, the licensing board shall suspend or revoke the 33 license of the licensee. 34 Section 1112. Health Care Stabilization and Provider Retention 35 Account. 36 (a) Fund established.--There is established within the 37 General Fund a special account to be known as the Health Care 38 Stabilization and Provider Retention Account. Funds in the 39 account shall be subject to an annual appropriation by the 40 General Assembly [to the Department of Public Welfare. The 41 Department of Public Welfare shall administer funds appropriated 42 under this section]. 43 (a.1) Abatement program appropriations.--Funds appropriated 44 to the Department of Public Welfare for the abatement program 45 shall be administered by the Department of Public Welfare 46 consistent with its duties under section 201(1) of the act of 47 June 13, 1967 (P.L.31, No.21), known as the Public Welfare Code. 48 (a.2) Health care stabilization appropriations.--Money in 49 the account shall be allocated annually by the Secretary of the 50 Budget as follows: 51 (1) Seventy-five million dollars shall be transferred to 52 be used for the small business health savings tax account tax 53 credit established under Chapter 13. 54 (2) Five million dollars shall be transferred to be used 55 for the disease management tax credit established under 56 Chapter 15. 57 (3) Five million dollars shall be transferred to be used 58 for the healthy living and wellness tax incentives 59 established under Chapter 17. SB1137A06050 - 7 -
1 (4) Five million dollars shall be transferred to the 2 Health Care Cost Containment Council to be used in accordance 3 with Chapter 21. 4 (5) Fifteen million dollars shall be transferred to the 5 Patient Safety Trust Fund for use by the Department of Public 6 Welfare for implementing section 407. 7 (6) Twenty-two million dollars shall be transferred to 8 the Low Income Health Care Access Fund to increase service in 9 accordance with Chapter 19. 10 (7) Ten million dollars shall be transferred to the 11 Medical Safety Automation Fund. 12 [(b) Transfers from Mcare Fund.--By December 31 of each 13 year, the Secretary of the Budget may transfer from the Medical 14 Care Availability and Reduction of Error (Mcare) Fund 15 established in section 712(a) to the account an amount equal to 16 the difference between the amount deposited under section 712(m) 17 and the amount granted as discounts under section 712(e)(2) for 18 that calendar year.] 19 (c) [Transfers] Abatement transfers from account.--The 20 Secretary of the Budget [may] shall annually transfer from the 21 account to the Medical Care Availability and Reduction of Error 22 (Mcare) Fund an amount [up] equal to the aggregate amount of 23 abatements granted by the Insurance Department under section 24 1104(b)[.], minus the sum of the amount deposited in the fund 25 under section 712(m) and any payments of the assessment levied 26 under section 712(d). 27 (d) Other deposits.--The Department of Public Welfare may 28 deposit any other funds received by the department which it 29 deems appropriate in the account. 30 [(e) Administration assistance.--The Insurance Department 31 shall provide assistance to the Department of Public Welfare in 32 administering the account.] 33 Section 5. Section 1115 of the act, amended October 27, 2006 34 (P.L.1198, No.128), is repealed: 35 [Section 1115. Expiration. 36 The Health Care Provider Retention Program established under 37 this chapter shall expire December 31, 2008.] 38 Section 6. The act is amended by adding a section to read: 39 Section 1116. Health Care Provider Retention Reserve Account. 40 (a) Establishment.--There is established within the General 41 Fund a special account to be known as the Health Care Provider 42 Retention Reserve Account. The funds in the account shall only 43 be used for the purpose of reducing unfunded liability under 44 Chapter 7. 45 (b) Transfer.--Notwithstanding any other provision of this 46 act, the Secretary of the Budget shall, as of December 31, 2007, 47 transfer all funds in the account into the Health Care Provider 48 Retention Reserve Account. 49 Section 6.1. The act is amended by adding chapters to read: 50 CHAPTER 13 51 SMALL BUSINESS HEALTH SAVINGS ACCOUNT TAX CREDIT 52 Section 1301. Scope. 53 This chapter relates to small business health savings account 54 tax credit. 55 Section 1302. Definitions. 56 The following words and phrases when used in this chapter 57 shall have the meanings given to them in this section unless the 58 context clearly indicates otherwise: 59 "Department." The Department of Revenue of the Commonwealth. SB1137A06050 - 8 -
1 "Employee" or "employees." An individual or group of 2 individuals employed by a small business. The term shall also 3 include a sole proprietor. 4 "Health insurance policy." An individual or group health, 5 sickness or accident policy or subscriber contract or 6 certificate issued by an entity subject to any one of the 7 following: 8 (1) The act of May 17, 1921 (P.L.682, No.284), known as 9 The Insurance Company Law of 1921. 10 (2) The act of December 29, 1972 (P.L.1701, No.364), 11 known as the Health Maintenance Organization Act. 12 (3) The act of May 18, 1976 (P.L.123, No.54), known as 13 the Individual Accident and Sickness Insurance Minimum 14 Standards Act. 15 (4) 40 Pa.C.S. Ch. 61 (relating to hospital plan 16 corporations) or 63 (relating to professional health services 17 plan corporations). 18 "Health Savings Account." As defined in section 223(d) of 19 the Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. 20 § 223(d)). 21 "Pass-through entity." Any of the following: 22 (1) A partnership, limited partnership, limited 23 liability company, business trust or other unincorporated 24 entity that for Federal income tax purposes is taxable as a 25 partnership. 26 (2) A Pennsylvania S corporation. 27 "Qualified high deductible health plan." A health insurance 28 policy that would qualify as a high deductible health plan under 29 section 223(c)(2) of the Internal Revenue Code of 1986 (Public 30 Law 99-514, 26 U.S.C. § 223(c)(2)). 31 "Qualified tax liability." The liability for taxes imposed 32 under Article III, IV or VI of the act of March 4, 1971 (P.L.6, 33 No.2), known as the Tax Reform Code of 1971. The term shall 34 include the liability for taxes imposed under Article III of the 35 Tax Reform Code of 1971 on an owner of a pass-through entity. 36 "Secretary." The Secretary of Revenue of the Commonwealth. 37 "Small business." An employer who, on at least 50% of its 38 working days during the taxable year, employed fewer than 100 39 employees. 40 "Tax credit." The small business health savings account tax 41 credit. 42 "Taxpayer." A small business subject to tax under Article 43 III, IV or VI of the act of March 4, 1971 (P.L.6, No.2), known 44 as the Tax Reform Code of 1971. The term includes: 45 (1) the partner, shareholder, owner or member of a pass- 46 through entity; or 47 (2) a sole proprietor. 48 Section 1303. Credit for Health Savings Account contributions. 49 (a) Application.--A taxpayer who purchases and provides a 50 qualified high deductible health insurance policy to employees 51 and makes a contribution to a health savings account on behalf 52 of employees in a taxable year may apply for a tax credit as 53 provided in this chapter. By September 15, a taxpayer must 54 submit an application to the department for the aggregate 55 contribution made by the taxpayer to employee health savings 56 accounts in the taxable year that ended in the prior calendar 57 year. 58 (b) Computation.--A taxpayer who qualifies under subsection 59 (a) shall receive a tax credit for the taxable year in SB1137A06050 - 9 -
1 accordance with the following: 2 (1) Fifty percent of the aggregate contribution made by 3 the taxpayer to employee health savings accounts when the 4 contribution is provided for the benefit of employees, 5 spouses and dependents for the taxable year. 6 (2) Twenty-five percent of the aggregate contribution 7 made by the taxpayer to employee health savings accounts when 8 the contribution is provided solely for the benefit of an 9 employee. 10 (c) Notification.--By December 15 of the calendar year 11 following the close of the taxable year during which the 12 contribution to employee health savings accounts was made, the 13 department shall notify the taxpayer of the amount of the 14 taxpayer's tax credit approved by the department. 15 Section 1304. Limitation on credits. 16 (a) Limit.--The total amount of credits approved by the 17 department shall not exceed $30,000,000 in any fiscal year. 18 (b) Calculation.--If the total amount of small business 19 health savings account tax credits applied for by all taxpayers 20 exceeds the amount allocated for those credits, then the small 21 business health savings account tax credit to be received by 22 each applicant shall be the product of the allocated amount 23 multiplied by the quotient of the small business health savings 24 account tax credit applied for by the applicant divided by the 25 total of all small business health savings account credits 26 applied for by all applicants, the algebraic equivalent of which 27 is: 28 taxpayer's small business health savings account tax 29 credit = amount allocated for those credits X (small 30 business health savings account tax credit applied for by 31 the applicant/total of all small business health savings 32 account tax credits applied for by all applicants). 33 Section 1305. Carryover, carryback, refund and assignment of 34 credit. 35 (a) Carryover.--If the taxpayer cannot use the entire amount 36 of the tax credit for the taxable year in which the tax credit 37 is first approved, then the excess may be carried over to 38 succeeding taxable years and used as a credit against the 39 qualified tax liability of the taxpayer for those taxable years. 40 Each time that the tax credit is carried over to a succeeding 41 taxable year, it is to be reduced by the amount that was used as 42 a credit during the immediately preceding taxable year. The tax 43 credit may be carried over and applied to succeeding taxable 44 years for no more than 15 taxable years following the first 45 taxable year for which the taxpayer was entitled to claim the 46 credit. 47 (b) Application of credit.--A tax credit approved by the 48 department for monetary contributions made to employee health 49 savings accounts in a taxable year first shall be applied 50 against the taxpayer's qualified tax liability for the current 51 taxable year as of the date on which the credit was approved 52 before the tax credit is applied against any tax liability under 53 subsection (a). 54 (c) Prohibition.--A taxpayer is not entitled to assign, 55 carry back or obtain a refund of an unused tax credit. 56 Section 1306. Shareholder, owner or member pass-through. 57 (a) Shareholder's calculation.--If a Pennsylvania S 58 corporation does not have an eligible tax liability against 59 which the tax credit may be applied, a shareholder of the SB1137A06050 - 10 -
1 Pennsylvania S corporation is entitled to a tax credit equal to 2 the tax credit determined for the Pennsylvania S corporation for 3 the taxable year multiplied by the percentage of the 4 Pennsylvania S corporation's distributive income to which the 5 shareholder is entitled. 6 (b) Owner or member calculation.--If a pass-through entity 7 other than a Pennsylvania S corporation does not have an 8 eligible tax liability against which the tax credit may be 9 applied, an owner or member of the pass-through entity is 10 entitled to a tax credit equal to the tax credit determined for 11 the pass-through entity for the taxable year multiplied by the 12 percentage of the pass-through entity's distributive income to 13 which the owner or member is entitled. 14 (c) Application; restrictions.--The credit provided under 15 subsection (a) or (b) is in addition to any tax credit to which 16 a shareholder, owner or member of a pass-through entity is 17 otherwise entitled under this chapter. However, a pass-through 18 entity and a shareholder, owner or member of a pass-through 19 entity may not claim a credit under this chapter for the same 20 contributions made to employee health savings accounts. 21 Section 1307. Report to General Assembly. 22 The secretary shall submit an annual report to the General 23 Assembly indicating the effectiveness of the credit provided by 24 this chapter no later than March 15 following the year in which 25 the credits were approved. The report shall include the names of 26 all taxpayers utilizing the credit as of the date of the report 27 and the amount of credits approved and utilized by each 28 taxpayer. Notwithstanding any law providing for the 29 confidentiality of tax records, the information contained in the 30 report shall be public information. The report may also include 31 any recommendations for changes in the calculation or 32 administration of the credit. 33 Section 1308. Regulations. 34 The secretary shall promulgate regulations necessary for the 35 implementation and administration of this chapter. 36 CHAPTER 15 37 DISEASE MANAGEMENT TAX CREDIT 38 Section 1501. Scope. 39 This chapter relates to disease management insurance policy 40 tax credits. 41 Section 1502. Definitions. 42 The following words and phrases when used in this chapter 43 shall have the meanings given to them in this section unless the 44 context clearly indicates otherwise: 45 "Department." The Department of Revenue of the Commonwealth. 46 "Disease management insurance policy." A group or individual 47 health insurance policy that includes a disease management 48 program. 49 "Disease management program." A set of interventions 50 designed to improve the health of individuals, especially those 51 with certain ailments or diseases. A disease management program 52 may include: 53 (1) Identifying patients and matching the intervention 54 with need. 55 (2) Support for adherence to evidence-based medical 56 practice guidelines, including providing medical treatment 57 guidelines to physicians and other providers, and providing 58 support services to assist the physician in monitoring the 59 patient. SB1137A06050 - 11 -
1 (3) Services designed to enhance patient management and 2 adherence to an individualized treatment plan, including 3 patient education, monitoring and reminders, and behavior 4 modification programs aimed at encouraging lifestyle changes. 5 (4) Routine reporting and feedback loops, including 6 communication with patient, physician, health plan and 7 ancillary providers, and practice profiling. 8 (5) Collection and analysis of process and outcome 9 measures. 10 "Pass-through entity." Any of the following: 11 (1) A partnership, limited partnership, limited 12 liability company, business trust or other unincorporated 13 entity that for Federal income tax purposes is taxable as a 14 partnership. 15 (2) A Pennsylvania S corporation. 16 "Primary contractor." A person licensed to conduct business 17 in this Commonwealth that develops, implements or monitors 18 disease management programs. 19 "Qualified tax liability." The liability for taxes imposed 20 under Article III (relating to personal income tax), IV 21 (relating to corporate net income tax) or VI (relating to 22 capital stock franchise tax) of the act of March 4, 1971 (P.L.6, 23 No.2), known as the Tax Reform Code of 1971. The term includes 24 the liability for taxes imposed under Article III of the Tax 25 Reform Code of 1971 on a sole proprietor, partner, shareholder, 26 owner or member of a pass-through entity. 27 "Secretary." The Secretary of Revenue of the Commonwealth. 28 "Service provider." A person licensed to conduct business in 29 this Commonwealth that is selected by the primary contractor to 30 provide disease management programs. 31 "Small business." A taxpayer with fewer than 50 employees. 32 "Tax credit." The disease management insurance policy tax 33 credit authorized under this chapter. 34 "Taxpayer." An entity subject to tax under Article III 35 (relating to personal income tax), IV (relating to corporate net 36 income tax) or VI (relating to capital stock franchise tax) of 37 the act of March 4, 1971 (P.L.6, No.2), known as the Tax Reform 38 Code of 1971. The term includes: 39 (1) the partner, shareholder, owner or member of a pass- 40 through entity that receives a tax credit; or 41 (2) a sole proprietor. 42 Section 1503. Credit for disease management insurance policies. 43 (a) Application.-- 44 (1) A taxpayer who purchases and provides a disease 45 management insurance policy to employees in a taxable year 46 may apply for a tax credit as provided in this chapter. By 47 September 15, a taxpayer must submit an application to the 48 department for premiums paid in the taxable year that ended 49 in the prior calendar year. 50 (2) A taxpayer with 50 or more employees who purchases 51 and provides a disease management insurance policy to 52 employees in a taxable year may apply for a tax credit as 53 provided in this chapter. By September 15, a taxpayer must 54 submit an application to the department for premiums paid in 55 the taxable year that ended in the prior calendar year. 56 (b) Tax credit.--A taxpayer qualified under subsection 57 (a)(1) shall receive a tax credit for the taxable year in the 58 amount of $500 for each employee of the taxpayer covered by a 59 disease management insurance policy. A taxpayer qualified under SB1137A06050 - 12 -
1 subsection (a)(2) shall receive a tax credit for the taxable 2 year in an amount equal to 50% of the cost to the taxpayer for 3 providing health care coverage for employees, contingent on 4 proof the purchased coverage utilizes disease management 5 protocols. 6 (c) Notification of credit.--By December 15 of the calendar 7 year following the close of the taxable year, the department 8 shall notify the taxpayer of the amount of the taxpayer's tax 9 credit approved by the department. 10 Section 1504. Certification requirement. 11 (a) Application.--In order to qualify for the tax credit, a 12 taxpayer, in conjunction with the Department of Labor and 13 Industry and the Insurance Department, shall make application 14 for the certification of the disease management program 15 purchased as part of the disease management insurance policy. 16 The Insurance Department shall develop the certification 17 criteria. 18 (b) Reapplying.--In the subsequent tax year, a taxpayer 19 reapplying for the tax credit must provide verification to the 20 Department of Labor and Industry and the Insurance Department 21 that the disease management program meets the certification 22 requirements and continues to be purchased by the taxpayer. 23 Section 1505. Carryover, carryback, refund and assignment of 24 credit. 25 (a) General rule.--If the taxpayer cannot use the entire 26 amount of the tax credit for the taxable year in which the tax 27 credit is first approved because the amount of the tax credit 28 exceeds the tax liability of the taxpayer for the year in which 29 the tax credit under section 1503 (relating to credit for 30 disease management insurance policies) is to be applied, the 31 excess may be carried over to succeeding taxable years and used 32 as a credit against the qualified tax liability of the taxpayer 33 for those taxable years. Each time the tax credit is carried 34 over to a succeeding taxable year, it shall be reduced by the 35 amount that was used as a credit during the immediately 36 preceding taxable year. The tax credit may be carried over and 37 applied to succeeding taxable years for no more than 15 taxable 38 years following the first taxable year for which the taxpayer 39 was entitled to claim the credit. 40 (b) Application of tax credit.--A tax credit approved by the 41 department for premiums incurred in a taxable year shall first 42 be applied against the taxpayer's qualified tax liability for 43 the current taxable year as of the date on which the credit was 44 approved before the tax credit may be applied against any tax 45 liability under subsection (a). 46 (c) Unused tax credit.--A taxpayer is not entitled to 47 assign, carry back or obtain a refund of an unused tax credit. 48 Section 1506. Time limitations. 49 A taxpayer is not entitled to a tax credit for health 50 insurance premiums providing for disease management programs 51 incurred in taxable years ending after December 31, 2010. 52 Section 1507. Limitation on credits. 53 (a) Allocation for small businesses.--Forty percent of 54 available funds shall be allocated exclusively for small 55 businesses. However, if the total amounts allocated to either 56 the group of applicants exclusive of small businesses or the 57 group of small business applicants is not approved in any fiscal 58 year, the unused portion will become available for use by other 59 qualifying taxpayers. SB1137A06050 - 13 -
1 (b) Proration of tax credits.-- 2 (1) If the total amount of tax credits applied for by 3 all taxpayers, exclusive of small businesses, exceeds the 4 amount allocated for those credits, the tax credit to be 5 received by each applicant shall be prorated by the 6 department among all applicants, exclusive of small 7 businesses, who have qualified for the credit. 8 (2) If the total amount of tax credits applied for by 9 all small businesses exceeds the amount allocated for those 10 credits, the tax credit to be received by each small business 11 applicant shall be prorated by the department among all small 12 business applicants who have qualified for the credit. 13 Section 1508. Shareholder, owner or member pass-through. 14 (a) Pennsylvania S corporations.--If a Pennsylvania S 15 corporation does not have an eligible tax liability against 16 which the tax credit may be applied, a shareholder of the 17 Pennsylvania S corporation is entitled to a tax credit equal to 18 the tax credit determined for the Pennsylvania S corporation for 19 the taxable year multiplied by the percentage of the 20 Pennsylvania S corporation's distributive income to which the 21 shareholder is entitled. 22 (b) Pass-through entities.--If a pass-through entity other 23 than a Pennsylvania S corporation does not have an eligible tax 24 liability against which the tax credit may be applied, an owner 25 or member of the pass-through entity is entitled to a tax credit 26 equal to the tax credit determined for the pass-through entity 27 for the taxable year multiplied by the percentage of the pass- 28 through entity's distributive income to which the owner or 29 member is entitled. 30 (c) Entitlement.--The credit provided under subsection (a) 31 or (b) is in addition to any tax credit to which a shareholder, 32 owner or member of a pass-through entity is otherwise entitled 33 under this chapter. However, a pass-through entity and a 34 shareholder, owner or member of a pass-through entity may not 35 claim a credit under this chapter for the same premium or 36 employee. 37 Section 1509. Accountability. 38 (a) Review procedures.--Any taxpayer that receives a tax 39 credit under this chapter shall be subject to a performance 40 review by the Department of Labor and Industry, in conjunction 41 with the Insurance Department. As appropriate, the performance 42 review shall be based upon information submitted to the 43 department that includes the following: 44 (1) The contractor's or service provider's strategic 45 goals and objectives for disease management programs. 46 (2) The contractor's or service provider's annual 47 performance plan setting forth how these strategic goals and 48 objectives are to be achieved and the specific methodology 49 for evaluating results, along with any proposed methods for 50 improvement. 51 (3) The contractor's or service provider's annual 52 performance report setting forth the specific results in 53 achieving its strategic goals and objectives for disease 54 management, including any changes in the health of 55 participants in the disease management program. 56 (4) The progress made in achieving expected program 57 priorities and goals. 58 (5) Any other information deemed necessary by the 59 department. SB1137A06050 - 14 -
1 (b) Penalty.--If a performance review indicates that a 2 primary contractor or a service provider failed to comply with 3 contract requirements or meet performance goals, taxpayers may 4 be subject to a reduction in or ineligibility for future tax 5 credit funding under this chapter. 6 Section 1510. Report to General Assembly. 7 (a) Submission of report.--The secretary shall submit an 8 annual report indicating the effectiveness of the credit 9 provided by this chapter no later than March 15 following the 10 year in which the credits were approved to the Governor, the 11 chairmen and the minority chairmen of the Public Health and 12 Welfare Committee and the Appropriations Committee of the Senate 13 and the chairmen and minority chairmen of the Health and Human 14 Services Committee and the Appropriations Committee of the House 15 of Representatives. 16 (b) Contents.--The report shall include the names of all 17 taxpayers utilizing the credit as of the date of the report and 18 the amount of credits approved and utilized by each taxpayer. 19 (c) Public information.--Notwithstanding any law providing 20 for the confidentiality of tax records, the information 21 contained in the report shall be public information. 22 (d) Recommendations.--The report may also include any 23 recommendations for changes in the calculation or administration 24 of the credit. 25 Section 1511. Termination. 26 The department shall not approve a tax credit under this 27 chapter for taxable years ending after December 31, 2010. 28 Section 1512. Regulations. 29 The secretary shall promulgate regulations necessary for the 30 implementation and administration of this chapter. 31 CHAPTER 17 32 HEALTHY LIVING AND WELLNESS TAX INCENTIVES 33 Section 1701. Scope. 34 This chapter relates to tax incentives for wellness services 35 and healthy living equipment and products. 36 Section 1702. Definitions. 37 The following words and phrases when used in this chapter 38 shall have the meanings given to them in this section unless the 39 context clearly indicates otherwise: 40 "Annual limitation." $2,500. 41 "Annual personal income tax return." The return required to 42 be filed under section 330 of the act of March 4, 1971 (P.L.6, 43 No.2), known as the Tax Reform Code of 1971. 44 "Code." The act of March 4, 1971 (P.L.6, No.2), known as the 45 Tax Reform Code of 1971. 46 "Department." The Department of Revenue of the Commonwealth. 47 "Healthy living product." Exercise equipment used in a 48 residential property, nutritional supplements purchased by a 49 taxpayer, a membership to a gym, exercise facility or a similar 50 facility, the cost of a class or a course providing for the 51 instruction of a physical activity, including martial arts, 52 sports, dance or similar activities. 53 "Qualified expense." The cost incurred for the purchase at 54 the sale at retail or use of a healthy living product or a 55 wellness service. 56 "Tax credit." The healthy living and wellness tax credit. 57 "Taxable income." The term shall have the same meaning as 58 given to it in section 301 of the act of March 4, 1971 (P.L.6, 59 No.2), known as the Tax Reform Code of 1971. SB1137A06050 - 15 -
1 "Taxpayer." The term shall have the same meaning as given to 2 it in section 301 of the act of March 4, 1971 (P.L.6, No.2), 3 known as the Tax Reform Code of 1971. 4 "Wellness service." Pregnancy care, fitness centers, weight 5 management, nicotine cessation, stress management and other 6 similar services. 7 Section 1703. Healthy living and wellness tax credit. 8 (a) Application.--A taxpayer may apply on the annual 9 personal income tax return for a tax credit for qualified 10 expenses as provided under this chapter. 11 (b) Department duties.--The following apply: 12 (1) The department shall provide a form by which a 13 taxpayer may apply for the tax credit. 14 (2) The department shall make the form available with 15 the annual personal income tax return. 16 (3) The department shall not grant a tax credit for a 17 qualified expense that was not incurred by the taxpayer. 18 (4) The department shall prescribe a method by which a 19 taxpayer may apply for the tax credit, including making 20 available a method by which a taxpayer may claim and provide 21 proof of qualified expenses when applying for the tax credit. 22 (5) The department shall grant a tax credit to a 23 taxpayer who satisfies the requirements of this section. 24 (c) Computation.--A taxpayer who applies under subsection 25 (a) shall be eligible to receive a tax credit for the taxable 26 year equal to the amount of qualified expenses incurred by the 27 taxpayer. 28 (d) Limitations.--The following apply: 29 (1) The amount of a tax credit awarded to a taxpayer 30 under this section shall not exceed the annual limitation. 31 (2) A taxpayer shall be ineligible for a tax credit if 32 the taxpayer is not up to date with all tax payments for tax 33 liabilities prior to the tax year for which a taxpayer is 34 applying for a tax credit. 35 (3) The amount of a tax credit awarded to a taxpayer 36 under this section shall not result in taxable income being 37 less than zero. 38 Section 1704. Sales and use tax exclusion. 39 In addition to the exclusions from tax provided for under 40 section 204 of the code, the sale at retail or use of healthy 41 living products and wellness services shall not be subject to 42 the tax imposed under Article II of the code. 43 Section 1705. Construction. 44 To the extent necessary, a term used in this chapter that is 45 not defined in section 1702 shall carry the same meaning given 46 to it under Article II or III of the code unless the context 47 clearly indicates otherwise. 48 Section 1706. Regulations. 49 The department shall promulgate rules and regulations as 50 necessary for effectuating the provisions of this chapter. 51 Section 1707. Applicability. 52 This chapter shall apply to taxable years beginning after 53 June 30, 2008. 54 CHAPTER 19 55 COMMUNITY-BASED HEALTH PROVIDER ASSISTANCE 56 Section 1901. Scope of chapter. 57 This chapter relates to community-based health provider 58 assistance. 59 Section 1902. Definitions. SB1137A06050 - 16 -
1 The following words and phrases when used in this chapter 2 shall have the meanings given to them in this section unless the 3 context clearly indicates otherwise: 4 "Community-based health care provider." Any of the following 5 nonprofit health care centers which provide primary health care 6 services: 7 (1) A federally qualified health center as defined under 8 section 1905(1)(2)(B) of the Social Security Act (49 Stat. 9 620, 42 U.S.C. § 1396d(1)(2)(B)). 10 (2) A rural health clinic as defined under section 11 1861(aa)(2)) of the Social Security Act (49 Stat. 620, 42 12 U.S.C. § 1395x(aa)(2)), certified by Medicare. 13 (3) A freestanding hospital clinic serving a federally 14 designated health care professional shortage area. 15 (4) A free or partial-pay health clinic which provides 16 services by volunteer medical providers. 17 "Department." The Department of Health of the Commonwealth. 18 "Health care provider." A health care facility or health 19 care practitioner as defined in the act of July 19, 1979 20 (P.L.130, No.48), known as the Health Care Facilities Act, a 21 group practice or a community-based health care provider. 22 "Medical assistance." A State program of medical assistance 23 established under Article IV(f) of the act of June 13, 1967 24 (P.L.31, No.21), known as the Public Welfare Code. 25 "Program." The Community-Based Health Provider Assistance 26 Program. 27 "Uncompensated care." The cost of reasonable and medically 28 necessary care provided to individuals unable or unwilling to 29 pay for services provided by a community-based health provider. 30 Section 1903. Program. 31 (a) Program established.--The Community-Based Health 32 Provider Assistance Program is established to provide grants to 33 community-based health providers to: 34 (1) Improve the access to and quality of health care in 35 this Commonwealth. 36 (2) Assist in covering the reasonable costs of providing 37 health care services, outreach and care management 38 opportunities to persons eligible to receive health care 39 services from or through community-based health providers. 40 (3) Improve access to medically necessary preventive, 41 curative and palliative physical, dental and behavioral 42 health care services offered by and through community-based 43 health providers, while reducing unnecessary or duplicative 44 services. 45 (4) Reduce the unnecessary utilization of emergency 46 health care services by supporting the development and 47 provision of effective alternatives offered by or through 48 community-based health providers. 49 (5) Improve the availability of quality health care 50 services offered by or through community-based health 51 providers for expectant mothers, women who have recently 52 given birth and their children. 53 (6) Promote the use of chronic care and disease 54 management protocols offered by or through community-based 55 health providers in an effort to optimize both individual 56 health outcomes and the use of health care resources. 57 (b) Administration.--The program shall be administered by 58 the department and shall be funded by annual transfers to the 59 Low Income Health Care Access Fund to support community-based SB1137A06050 - 17 -
1 health providers' provision of health care. 2 (c) Department responsibilities.--The department shall have 3 the following powers and duties: 4 (1) Administer the program. 5 (2) Within 90 days of the effective date of this 6 section, develop and provide an application form consistent 7 with this chapter. 8 (3) Determine the eligibility of community-based health 9 providers for the assistance provided under this chapter, 10 based upon its consideration of revenue and cost data and 11 other information provided by community health providers, as 12 well as such other information as the department determines 13 to be appropriate to reflect the financial condition and 14 needs of such centers and the Commonwealth. 15 (4) Establish a process to allocate funding as provided 16 under this chapter, to determine the optimal use of funds and 17 to reallocate funds if acceptable requests for funding within 18 a particular category are not received. 19 (5) Calculate and make payments to qualified community 20 health providers from the funds deposited in the Low Income 21 Health Care Access Fund. 22 (6) Provide an annual report to the chairman and 23 minority chairman of the Public Health and Welfare Committee 24 of the Senate and the chairman and minority chairman of the 25 Health and Human Services Committee of the House of 26 Representatives describing the operation of the program and 27 detailing grants made, the names and addresses of the 28 community-based health providers receiving grants and such 29 other information as may be determined by the department to 30 be necessary or desirable. 31 (7) Audit grants awarded under this chapter to ensure 32 that funds have been used in accordance with the terms and 33 standards adopted by the department. 34 (8) Provide ongoing assessment of the benefits and costs 35 of the assistance provided under this chapter. 36 (d) Other funding sources.--The Commonwealth is authorized 37 and directed to seek Federal matching funds under medical 38 assistance, as well as grants and funding from other sources, to 39 supplement amounts made available under this chapter to the 40 extent permitted by law. 41 (e) Limitations on payments by department.--Payments made 42 under this chapter in a fiscal year shall not exceed the amount 43 of funds available in the Low Income Health Care Access Fund for 44 the program and any payment under this chapter shall not 45 constitute an entitlement from the Commonwealth or a claim on 46 any other funds of the Commonwealth. 47 (f) Report.--Each community-based health provider receiving 48 a grant under this chapter shall report at least annually to the 49 department, as specified by the department, and shall include 50 all of the following: 51 (1) The efforts undertaken to improve access to and the 52 delivery and management of health care services. 53 (2) The reduction of unnecessary and duplicative health 54 care services. 55 (3) The improvements in overall health indicators and in 56 utilization of health care services, with particular emphasis 57 on indicators including an assessment of: 58 (i) The establishment of relationships between 59 providers and individuals directed toward funding medical SB1137A06050 - 18 -
1 homes for such persons, as well as the provision of 2 preventive and chronic care management services. 3 (ii) The care of expectant mothers. 4 (iii) Postpartum care of mothers. 5 (iv) The care of newborn children and infants. 6 (4) An accounting of the expenditure of funds from the 7 grant and all funds received from other sources. 8 Section 1904. Grants to community-based health providers. 9 (a) Allocation of funds.--The department shall provide grant 10 assistance to community health providers on the basis of the 11 process established in this section, subject to reallocation as 12 provided under subsection (f). 13 (b) Method of awarding grants.--The department shall develop 14 a methodology to determine grant amounts to be awarded under 15 this chapter, based upon community need for the services to be 16 supported by funding provided to community-based health 17 providers. It is the intent of the General Assembly that during 18 the first three years of the program the department shall use 19 its best efforts to make grants as follows, subject to 20 reallocation as provided under subsection (f): 21 (1) Twelve million dollars for expansion of current 22 community-based health providers or development of new 23 community-based health providers. 24 (2) Five million dollars for improvements in prenatal, 25 obstetrics, postpartum and newborn care provided by or 26 through community-based health providers. 27 (3) Five million dollars for services intended to reduce 28 unnecessary emergency room utilization and to expand capacity 29 and services offered by or through existing community-based 30 health providers. 31 (c) Additional information.--In addition to the application, 32 the applicant shall provide: 33 (1) A feasibility study of the proposed uses of funds to 34 be provided under the grant. 35 (2) A business or financial plan that describes the 36 long-term sustainability, financial cost to the applicant and 37 the proposed benefits of the work to be accomplished pursuant 38 to the grant. 39 (3) A strategic plan and schedule for the development 40 and implementation of the work to be accomplished under the 41 grant. 42 (d) Limitation.--The amount of a grant to any specific 43 community-based health care provider under this program shall 44 not exceed $2,000,000 and shall be for a term of not more than 45 five years. 46 (e) Reallocation.--The department shall reallocate funds 47 among the categories provided under subsection (b) if sufficient 48 requests are not received by the department that comply with 49 this chapter or the requirements of the department. 50 Section 1905. Low Income Health Care Access Fund. 51 (a) Restricted account established.--There is established a 52 restricted account in the Mcare Fund, to be known as the Low 53 Income Health Care Access Fund. 54 (b) Funding.--The Low Income Health Care Access Fund shall 55 be funded by: 56 (1) Appropriations to the Low Income Health Care Access 57 Fund. 58 (2) Money received from the Federal Government or other 59 sources. SB1137A06050 - 19 -
1 (3) Money required to be deposited in the Low Income 2 Health Care Access Fund pursuant to other provisions of this 3 chapter or any other law. 4 (4) Return on money in the Low Income Health Care Access 5 Fund, net of investment costs. 6 (c) Nonlapse.--The money in the Low Income Health Care 7 Access Fund is continuously appropriated to the Low Income 8 Health Care Access Fund and shall not lapse at the end of any 9 fiscal year. 10 CHAPTER 21 11 HEALTH CARE COMPARISON 12 Section 2101. Definitions. 13 The following words and phrases when used in this chapter 14 shall have the meanings given to them in this section unless the 15 context clearly indicates otherwise: 16 "Adult basic." The health investment insurance program 17 established under Chapter 13 of the act of June 26, 2001 18 (P.L.755, No.77), known as the Tobacco Settlement Act. 19 "Ambulatory service facility." A facility licensed in this 20 Commonwealth, not part of a hospital, which provides medical, 21 diagnostic or surgical treatment to patients not requiring 22 hospitalization, including ambulatory surgical facilities, 23 ambulatory imaging or diagnostic centers, birthing centers, 24 freestanding emergency rooms and any other facilities providing 25 ambulatory care which charge a separate facility charge. 26 Physician's offices and offices of other licensed health care 27 providers, whether in group or individual practices, shall be 28 considered ambulatory service facilities for the purposes of 29 this act. 30 "Children's Health Insurance Program" or "CHIP." The program 31 established under Article XXIII of the act of May 17, 1921 32 (P.L.682, No.284), known as The Insurance Company Law of 1921. 33 "Council." The Health Care Cost Containment Council. 34 "Covered services." Any health care services or procedures 35 connected with episodes of illness that require either inpatient 36 hospital care or major ambulatory service such as surgical, 37 medical or major radiological procedures, including any initial 38 and follow-up outpatient services associated with the episode of 39 illness before, during or after inpatient hospital care or major 40 ambulatory service. The term includes routine outpatient 41 services connected with episodes of illness that do not require 42 hospitalization or major ambulatory service, including all 43 office visits to physicians, chiropractors and other data 44 sources including other licensed health care providers. 45 "Data source." A hospital; ambulatory service facility; 46 physician; audiologist; birthing center; chiropractor; dentist; 47 doctor of medicine; mental health professional including 48 psychologists; nurse practitioner; optometrist; osteopath; 49 physical therapist; podiatrist; speech pathologist or other 50 licensed health care provider; health maintenance organization 51 as defined in the act of December 29, 1972 (P.L.1701, No.364), 52 known as the Health Maintenance Organization Act; hospital, 53 medical or health service plan with a certificate of authority 54 issued by the Insurance Department, including, but not limited 55 to, hospital plan corporations as defined in 40 Pa.C.S. Ch. 61 56 (relating to hospital plan corporations) and professional health 57 services plan corporations as defined in 40 Pa.C.S. Ch. 63 58 (relating to professional health services plan corporations); 59 commercial insurer with a certificate of authority issued by the SB1137A06050 - 20 -
1 Insurance Department providing health or accident insurance; 2 self-insured employer providing health or accident coverage or 3 benefits for employees employed in the Commonwealth; 4 administrator of a self-insured or partially self-insured health 5 or accident plan providing covered services in the Commonwealth; 6 any health and welfare fund that provides health or accident 7 benefits or insurance pertaining to covered service in the 8 Commonwealth; the Department of Public Welfare for those covered 9 services it purchases or provides through the medical assistance 10 program under the act of June 13, 1967 (P.L.31, No.21), known as 11 the Public Welfare Code, and any other payor for covered 12 services in the Commonwealth other than an individual. This term 13 shall also include physicians. 14 "Health care facility." A general or special hospital, 15 including tuberculosis and psychiatric hospitals, kidney disease 16 treatment centers, including freestanding hemodialysis units, 17 birthing centers, offices of physicians, chiropractors and other 18 data sources including other licensed health care providers, and 19 ambulatory service facilities as defined in this section, and 20 hospices, both profit and nonprofit, and including those 21 operated by an agency of State or local government. 22 "Licensee." An individual who is a data source and is 23 licensed or certified by the Commonwealth of Pennsylvania to 24 provide a covered service in a hospital, an office or other 25 health care facility in this Commonwealth. 26 "Medical assistance." Medical treatment which is subsidized 27 or completely paid for by the Commonwealth under Article IV of 28 the act of June 13, 1967 (P.L.31, No.21), known as the Public 29 Welfare Code. 30 "Medicare." The program established under Title XVIII of the 31 Social Security Act (Public Law 74-271, 42 U.S.C. § 1395 et 32 seq.). 33 "Other licensed health care provider." Any of the following: 34 (1) a licensee; 35 (2) a health care facility; or 36 (3) an officer, employee or entity of a licensee or 37 health care facility acting in the course and scope of 38 employment. 39 "Physician." An individual licensed under the laws of this 40 Commonwealth to practice medicine or surgery within the scope of 41 the act of October 5, 1978 (P.L.1109, No.261), known as the 42 Osteopathic Medical Practice Act, or the act of December 20, 43 1985 (P.L.457, No.112), known as the Medical Practice Act of 44 1985. The term includes other licensed health care providers. 45 "Provider." A hospital, an ambulatory service facility or a 46 physician or a data source, a birthing center or other licensed 47 health care provider. 48 "Work group." The data abstraction and technology work group 49 established by the council under section 6(a.1) of the act of 50 July 8, 1986 (P.L.408, No.89), known as the Health Care Cost 51 Containment Act. 52 Section 2102. Powers and duties of council. 53 The council is hereby authorized to and shall compile and 54 establish an Internet database for the general public showing 55 physician charge comparisons for common services and treatments. 56 Section 2103. Data submission and collection. 57 (a) Abstraction and technology work group.-- 58 (1) The work group shall develop a system of data 59 collection and analysis on physician charges for common SB1137A06050 - 21 -
1 services and treatments working with council staff and 2 outside third-party venders as needed and authorized by the 3 council. The analysis shall provide a methodology for 4 developing a charge comparison Internet search capability 5 showing most commonly utilized medical services and 6 treatments. 7 (2) The work group will, as part of its analysis, 8 examine physician charge comparison systems used in other 9 states as an addendum to its report identifying which 10 components of those other state systems are applicable or 11 appropriate to Pennsylvania. This analysis of other states 12 shall include descriptions as to how the physician charge 13 data is collected and shall include a recommendation to the 14 council, as to the most efficient, cost-effective and least 15 intrusive way to determine the physician charge comparisons 16 for common utilized services and treatments. The work group 17 recommendation to the council shall contain comparison by 18 common physician service or treatment and geographic location 19 of the physician searchable by county. 20 (3) This physician charge comparison shall also contain 21 data on reimbursement rates for adult basic, CHIP, Medicaid, 22 medical assistance, Medicare and insurer reimbursement rates 23 by insurer. 24 (4) The work group shall report its recommendations to 25 the council no later than 180 days after the effective date 26 of this section. The physician charge comparison described in 27 this paragraph shall be available to consumers beginning 28 January 1, 2009, or sooner. 29 (b) Data elements.--For each covered service performed in 30 Pennsylvania, the council shall be required to collect charges 31 from physicians for commonly utilized treatments as approved by 32 the council in accordance with subsection(a)(4). 33 Section 7. Section 1211 of the act of March 4, 1971 (P.L.6, 34 No.2), known as the Tax Reform Code of 1971, is repealed insofar 35 as it is inconsistent with the provisions of this act. 36 Section 8. All surcharges levied under 75 Pa.C.S. § 6506(a) 37 shall be transferred to the Hazardous Sites Cleanup Fund on and 38 after the effective date of this section. 39 Section 9. This act shall take effect as follows: 40 (1) Section 8 of this act shall take effect December 31, 41 2007, or immediately, whichever is later. 42 (2) The following provisions shall take effect July 1, 43 2008, or immediately, whichever is later: 44 (i) The repeal of section 712(e) of the act. 45 (ii) The amendment of the definition of "account" in 46 section 1101 of the act. 47 (iii) The amendment of section 1102(a) of the act. 48 (iv) The amendment of section 1105 of the act. 49 (v) The amendment of section 1112 of the act. 50 (vi) The addition of section 1116 of the act. 51 (vii) The addition of Chapter 13 of the act. 52 (viii) The addition of Chapter 15 of the act. 53 (ix) The addition of Chapter 17 of the act. 54 (x) The addition of Chapter 19 of the act. 55 (3) The remainder of this act shall take effect 56 immediately. C10L90VDL/SB1137A06050 - 22 -