Section 2171. Health Care Provider [and Managed Care Plan],
Insurer, MCO and Contractor Protection.--(a) [A managed care
plan] An insurer, MCO or contractor shall not exclude,
discriminate against or penalize any health care provider for
its refusal to allow, perform, participate in or refer for
health care services when the refusal of the health care
provider is based on moral or religious grounds and that
provider makes adequate information available to enrollees or,
if applicable, prospective enrollees.
(b) No public institution, public official or public agency
may take disciplinary action against, deny licensure or
certification or penalize any person, association or corporation
attempting to establish a [plan] health insurance policy, MCO
contract, CHIP contract or operating, expanding or improving an
existing [plan] health insurance policy, MCO contract or CHIP
contract because the person, association or corporation refuses
to provide any particular form of health care services or other
services or supplies covered by other [plans] health insurance
policies, MCO contracts or CHIP contracts when the refusal is
based on moral or religious grounds.
Section 2181. Departmental Powers and Duties.--(a) The
department shall require that records and documents submitted to
[a managed care plan] an insurer, MCO, contractor or utilization
review entity as part of any complaint or grievance be made
available to the department, upon request, for purposes of
enforcement or compliance with this article.
(b) The department shall compile data received from [a
managed care plan] an insurer, MCO or contractor on an annual
basis regarding the number, type and disposition of complaints
and grievances filed with [a managed care plan] an insurer, MCO
or contractor under this article.
(c) The department shall issue guidelines identifying those
provisions of this article that exceed or are not included in
the "Standards for the Accreditation of Managed Care
Organizations" published by the National Committee for Quality
Assurance. These guidelines shall be published in the
Pennsylvania Bulletin and updated as necessary. Copies of the
guidelines shall be made available to [managed care plans]
insurers, MCOs, contractors, health care providers and enrollees
upon request.
(d) The department and the Insurance Department shall ensure
compliance with this article. The appropriate department shall
investigate potential violations of the article based upon
information received from enrollees, health care providers and
other sources in order to ensure compliance with this article.
(e) The department and the Insurance Department shall
promulgate such regulations as may be necessary to carry out the
provisions of this article.
(f) The department in cooperation with the Insurance
Department shall submit an annual report to the General Assembly
regarding the implementation, operation and enforcement of this
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