PRIOR PRINTER'S NO. 398 PRINTER'S NO. 955
No. 387 Session of 2003
INTRODUCED BY M. WHITE, MOWERY, WENGER, KUKOVICH, PILEGGI, DENT,
LAVALLE, MUSTO, ERICKSON, PUNT, CORMAN, SCHWARTZ, GREENLEAF,
RAFFERTY, ORIE, KASUNIC, PICCOLA, TARTAGLIONE, MADIGAN,
STACK, WONDERLING, WOZNIAK, RHOADES, THOMPSON AND BOSCOLA,
MARCH 3, 2003
SENATOR MOWERY, PUBLIC HEALTH AND WELFARE, AS AMENDED,
JUNE 10, 2003
AN ACT
1 Amending the act of July 8, 1986 (P.L.408, No.89), entitled, as
2 reenacted and amended, "An act providing for the creation of
3 the Health Care Cost Containment Council, for its powers and
4 duties, for health care cost containment through the
5 collection and dissemination of data, for public
6 accountability of health care costs and for health care for
7 the indigent; and making an appropriation," repealing the <--
8 expiration date of the act. FURTHER PROVIDING FOR MEMBERSHIP <--
9 OF THE COUNCIL, ITS BYLAWS AND TERMS OF ITS MEMBERS, FOR
10 POWERS AND DUTIES OF THE COUNCIL, FOR DATA SUBMISSION AND
11 COLLECTION, FOR DATA DISSEMINATION AND PUBLICATION, FOR
12 ACCESS TO COUNCIL DATA AND FOR ENFORCEMENT AND PENALTIES;
13 REQUIRING A CERTAIN REPORT FROM THE LEGISLATIVE BUDGET AND
14 FINANCE COMMITTEE; AND EXTENDING THE SUNSET DATE OF THE ACT.
15 The General Assembly of the Commonwealth of Pennsylvania
16 hereby enacts as follows:
17 Section 1. Section 19 of the act of July 8, 1986 (P.L.408, <--
18 No.89), known as the Health Care Cost Containment Act, reenacted
19 and amended June 28, 1993 (P.L.146, No.34), is repealed.
20 Section 2. This act shall take effect immediately.
21 SECTION 1. SECTIONS 4(B), (D) AND (F) AND 5(B) AND (D)(11) <--
22 OF THE ACT OF JULY 8, 1986 (P.L.408, NO.89), KNOWN AS THE HEALTH
1 CARE COST CONTAINMENT ACT, REENACTED AND AMENDED JUNE 28, 1993
2 (P.L.146, NO.34), ARE AMENDED TO READ:
3 SECTION 4. HEALTH CARE COST CONTAINMENT COUNCIL.
4 * * *
5 (B) COMPOSITION.--THE COUNCIL SHALL CONSIST OF 21 VOTING
6 MEMBERS, COMPOSED OF AND APPOINTED IN ACCORDANCE WITH THE
7 FOLLOWING:
8 (1) THE SECRETARY OF HEALTH.
9 (2) THE SECRETARY OF PUBLIC WELFARE.
10 (3) THE INSURANCE COMMISSIONER.
11 (3.1) FOUR MEMBERS OF THE GENERAL ASSEMBLY, WHICH SHALL
12 CONSIST OF THE CHAIRMAN AND MINORITY CHAIRMAN OF THE PUBLIC
13 HEALTH AND WELFARE COMMITTEE OF THE SENATE AND THE CHAIRMAN
14 AND MINORITY CHAIRMAN OF THE HEALTH AND HUMAN SERVICES
15 COMMITTEE OF THE HOUSE OF REPRESENTATIVES. MEMBERS UNDER THIS
16 PARAGRAPH MAY APPOINT A DESIGNEE TO ACT ON BEHALF OF THE
17 MEMBER AT MEETINGS OF COMMITTEES, AS PROVIDED IN SUBSECTION
18 (F). DESIGNEES SHALL BE COUNTED FOR PURPOSES OF DETERMINING A
19 QUORUM.
20 (4) SIX REPRESENTATIVES OF THE BUSINESS COMMUNITY, AT
21 LEAST ONE OF WHOM REPRESENTS SMALL BUSINESS, WHO ARE
22 PURCHASERS OF HEALTH CARE AS DEFINED IN SECTION 3, NONE OF
23 WHICH IS PRIMARILY INVOLVED IN THE PROVISION OF HEALTH CARE
24 OR HEALTH INSURANCE, THREE OF WHICH SHALL BE APPOINTED BY THE
25 PRESIDENT PRO TEMPORE OF THE SENATE AND THREE OF WHICH SHALL
26 BE APPOINTED BY THE SPEAKER OF THE HOUSE OF REPRESENTATIVES
27 FROM A LIST OF TWELVE QUALIFIED PERSONS RECOMMENDED BY THE
28 PENNSYLVANIA CHAMBER OF BUSINESS AND INDUSTRY. THREE NOMINEES
29 SHALL BE REPRESENTATIVES OF SMALL BUSINESS.
30 (5) SIX REPRESENTATIVES OF ORGANIZED LABOR, THREE OF
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1 WHICH SHALL BE APPOINTED BY THE PRESIDENT PRO TEMPORE OF THE
2 SENATE AND THREE OF WHICH SHALL BE APPOINTED BY THE SPEAKER
3 OF THE HOUSE OF REPRESENTATIVES FROM A LIST OF TWELVE
4 QUALIFIED PERSONS RECOMMENDED BY THE PENNSYLVANIA AFL-CIO.
5 (6) ONE REPRESENTATIVE OF CONSUMERS WHO IS NOT PRIMARILY
6 INVOLVED IN THE PROVISION OF HEALTH CARE OR HEALTH CARE
7 INSURANCE, APPOINTED BY THE GOVERNOR FROM A LIST OF THREE
8 QUALIFIED PERSONS RECOMMENDED JOINTLY BY THE SPEAKER OF THE
9 HOUSE OF REPRESENTATIVES AND THE PRESIDENT PRO TEMPORE OF THE
10 SENATE.
11 (7) [ONE REPRESENTATIVE] TWO REPRESENTATIVES OF
12 HOSPITALS, APPOINTED BY THE GOVERNOR FROM A LIST OF [THREE]
13 FIVE QUALIFIED HOSPITAL REPRESENTATIVES RECOMMENDED BY THE
14 HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA. THE
15 [REPRESENTATIVE] REPRESENTATIVES UNDER THIS PARAGRAPH MAY
16 EACH APPOINT TWO ADDITIONAL DELEGATES TO ACT FOR THE
17 REPRESENTATIVE ONLY AT MEETINGS OF COMMITTEES, AS PROVIDED
18 FOR IN SUBSECTION (F).
19 (8) ONE REPRESENTATIVE OF PHYSICIANS, APPOINTED BY THE
20 GOVERNOR FROM A LIST OF THREE QUALIFIED PHYSICIAN
21 REPRESENTATIVES RECOMMENDED JOINTLY BY THE PENNSYLVANIA
22 MEDICAL SOCIETY AND THE PENNSYLVANIA OSTEOPATHIC MEDICAL
23 SOCIETY. THE REPRESENTATIVE UNDER THIS PARAGRAPH MAY APPOINT
24 TWO ADDITIONAL DELEGATES TO ACT FOR THE REPRESENTATIVE ONLY
25 AT MEETINGS OF COMMITTEES, AS PROVIDED FOR IN SUBSECTION (F).
26 (8.1) ONE REPRESENTATIVE OF NURSES, APPOINTED BY THE
27 GOVERNOR FROM A LIST OF THREE QUALIFIED REPRESENTATIVES
28 RECOMMENDED BY THE PENNSYLVANIA STATE NURSES ASSOCIATION.
29 (9) ONE REPRESENTATIVE OF THE BLUE CROSS AND BLUE SHIELD
30 PLANS IN PENNSYLVANIA, APPOINTED BY THE GOVERNOR FROM A LIST
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1 OF THREE QUALIFIED PERSONS RECOMMENDED JOINTLY BY THE BLUE
2 CROSS AND BLUE SHIELD PLANS OF PENNSYLVANIA.
3 (10) ONE REPRESENTATIVE OF COMMERCIAL INSURANCE
4 CARRIERS, APPOINTED BY THE GOVERNOR FROM A LIST OF THREE
5 QUALIFIED PERSONS RECOMMENDED BY THE INSURANCE FEDERATION OF
6 PENNSYLVANIA, INC.
7 (11) ONE REPRESENTATIVE OF HEALTH MAINTENANCE
8 ORGANIZATIONS, APPOINTED BY THE GOVERNOR FROM A LIST OF THREE
9 QUALIFIED PERSONS RECOMMENDED BY THE [PENNSYLVANIA
10 ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS] MANAGED CARE
11 ASSOCIATION OF PENNSYLVANIA.
12 (12) IN THE CASE OF EACH APPOINTMENT TO BE MADE FROM A
13 LIST SUPPLIED BY A SPECIFIED ORGANIZATION, IT IS INCUMBENT
14 UPON THAT ORGANIZATION TO CONSULT WITH AND PROVIDE A LIST
15 WHICH REFLECTS THE INPUT OF OTHER EQUIVALENT ORGANIZATIONS
16 REPRESENTING SIMILAR INTERESTS. EACH APPOINTING AUTHORITY
17 WILL HAVE THE DISCRETION TO REQUEST ADDITIONS TO THE LIST
18 ORIGINALLY SUBMITTED. ADDITIONAL NAMES WILL BE PROVIDED NOT
19 LATER THAN 15 DAYS AFTER SUCH REQUEST. APPOINTMENTS SHALL BE
20 MADE BY THE APPOINTING AUTHORITY NO LATER THAN 90 DAYS AFTER
21 RECEIPT OF THE ORIGINAL LIST. IF, FOR ANY REASON, ANY
22 SPECIFIED ORGANIZATION SUPPLYING A LIST SHOULD CEASE TO
23 EXIST, THEN THE RESPECTIVE APPOINTING AUTHORITY SHALL SPECIFY
24 A NEW EQUIVALENT ORGANIZATION TO FULFILL THE RESPONSIBILITIES
25 OF THIS ACT.
26 * * *
27 (D) QUORUM.--[ELEVEN] FOURTEEN MEMBERS, A MAJORITY OF WHICH
28 IN ANY COMBINATION SHALL BE MADE UP OF REPRESENTATIVES OF
29 BUSINESS AND LABOR, SHALL CONSTITUTE A QUORUM FOR THE
30 TRANSACTION OF ANY BUSINESS, AND THE ACT BY THE MAJORITY OF THE
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1 MEMBERS PRESENT AT ANY MEETING IN WHICH THERE IS A QUORUM SHALL
2 BE DEEMED TO BE THE ACT OF THE COUNCIL.
3 * * *
4 (F) BYLAWS.--THE COUNCIL SHALL ADOPT BYLAWS, NOT
5 INCONSISTENT WITH THIS ACT, AND MAY APPOINT SUCH COMMITTEES OR
6 ELECT SUCH OFFICERS SUBORDINATE TO THOSE PROVIDED FOR IN
7 SUBSECTION (C) AS IT DEEMS ADVISABLE. THE COUNCIL SHALL PROVIDE
8 FOR THE APPROVAL AND PARTICIPATION OF ADDITIONAL DELEGATES
9 APPOINTED UNDER SUBSECTION (B)(7) AND (8) SO THAT EACH
10 ORGANIZATION REPRESENTED BY DELEGATES UNDER THOSE PARAGRAPHS
11 SHALL NOT HAVE MORE THAN ONE VOTE ON ANY COMMITTEE TO WHICH THEY
12 ARE APPOINTED. THE COUNCIL SHALL ALSO APPOINT A TECHNICAL
13 ADVISORY GROUP WHICH SHALL, ON AN AD HOC BASIS, RESPOND TO
14 ISSUES PRESENTED TO IT BY THE COUNCIL OR COMMITTEES OF THE
15 COUNCIL AND SHALL MAKE RECOMMENDATIONS TO THE COUNCIL. THE
16 TECHNICAL ADVISORY GROUP SHALL INCLUDE PHYSICIANS, RESEARCHERS
17 AND BIOSTATISTICIANS. IN APPOINTING THE TECHNICAL ADVISORY
18 GROUP, THE COUNCIL SHALL CONSULT WITH AND TAKE NOMINATIONS FROM
19 THE REPRESENTATIVES OF THE HOSPITAL ASSOCIATION OF PENNSYLVANIA,
20 THE PENNSYLVANIA MEDICAL SOCIETY, THE PENNSYLVANIA OSTEOPATHIC
21 MEDICAL SOCIETY OR OTHER LIKE ORGANIZATIONS. AT ITS DISCRETION,
22 NOMINATIONS SHALL BE APPROVED BY THE EXECUTIVE COMMITTEE OF THE
23 COUNCIL. THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF
24 PENNSYLVANIA AND THE PENNSYLVANIA MEDICAL SOCIETY SHALL EACH BE
25 AFFORDED ONE REPRESENTATIVE NOT SUBJECT TO EXECUTIVE COMMITTEE
26 APPROVAL. IF THE SUBJECT MATTER OF ANY PROJECT EXCEEDS THE
27 EXPERTISE OF THE TECHNICAL ADVISORY GROUP, PHYSICIANS IN
28 APPROPRIATE SPECIALTIES WHO POSSESS CURRENT KNOWLEDGE OF THE
29 ISSUE UNDER STUDY MAY BE CONSULTED. THE TECHNICAL ADVISORY GROUP
30 SHALL ALSO REVIEW THE AVAILABILITY AND RELIABILITY OF SEVERITY
20030S0387B0955 - 5 -
1 OF ILLNESS MEASUREMENTS AS THEY RELATE TO SMALL HOSPITALS AND
2 PSYCHIATRIC, REHABILITATION AND CHILDREN'S HOSPITALS AND SHALL
3 MAKE RECOMMENDATIONS TO THE COUNCIL BASED UPON THIS REVIEW.
4 * * *
5 SECTION 5. POWERS AND DUTIES OF THE COUNCIL.
6 * * *
7 (B) RULES AND REGULATIONS.--THE COUNCIL [MAY, IN A MANNER
8 PROVIDED BY LAW,] SHALL PROMULGATE RULES AND REGULATIONS IN
9 ACCORDANCE WITH THE ACT OF JUNE 25, 1982 (P.L.633, NO.181),
10 KNOWN AS THE REGULATORY REVIEW ACT, NECESSARY TO CARRY OUT ITS
11 DUTIES UNDER THIS ACT.
12 * * *
13 (D) GENERAL DUTIES AND FUNCTIONS.--THE COUNCIL IS HEREBY
14 AUTHORIZED TO AND SHALL PERFORM THE FOLLOWING DUTIES AND
15 FUNCTIONS:
16 * * *
17 [(11) ADOPT, WITHIN ONE YEAR, A MODEL PATIENT ITEMIZED
18 STATEMENT FOR ALL PROVIDERS, WHICH ITEMIZES ALL CHARGES FOR
19 SERVICES, EQUIPMENT, SUPPLIES AND MEDICINE, DESIGNED TO BE
20 MORE UNDERSTANDABLE THAN CURRENT PATIENT BILLS. EACH PROVIDER
21 SHALL BE REQUIRED TO UTILIZE SAID MODEL PATIENT ITEMIZED
22 STATEMENT FOR COVERED SERVICES WITHIN 90 DAYS OF ADOPTION OF
23 SAID FORM BY THE COUNCIL. SUCH MODEL PATIENT ITEMIZED
24 STATEMENTS SHALL BE WRITTEN IN LANGUAGE THAT IS
25 UNDERSTANDABLE TO THE AVERAGE PERSON AND BE PRESENTED TO EACH
26 PATIENT UPON DISCHARGE FROM A HEALTH CARE FACILITY OR
27 PROVISION OF PATIENT SERVICES OR WITHIN A REASONABLE TIME
28 THEREAFTER. PATIENTS MAY REQUEST A COPY OF THEIR PENNSYLVANIA
29 UNIFORM CLAIMS AND BILLING FORM, AND, UPON REQUEST, THE
30 PROVIDER SHALL FURNISH THIS FORM TO THE PATIENT WITHIN 30
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1 DAYS.]
2 * * *
3 SECTION 2. SECTION 6(A) AND (D) OF THE ACT ARE AMENDED AND
4 THE SECTION IS AMENDED BY ADDING A SUBSECTION TO READ:
5 SECTION 6. DATA SUBMISSION AND COLLECTION.
6 (A) SUBMISSION OF DATA.--
7 (1) THE COUNCIL IS HEREBY AUTHORIZED TO COLLECT AND DATA
8 SOURCES ARE HEREBY REQUIRED TO SUBMIT, UPON REQUEST OF THE
9 COUNCIL, ALL DATA REQUIRED IN THIS SECTION, ACCORDING TO
10 UNIFORM SUBMISSION FORMATS, CODING SYSTEMS AND OTHER
11 TECHNICAL SPECIFICATIONS NECESSARY TO RENDER THE INCOMING
12 DATA SUBSTANTIALLY VALID, CONSISTENT, COMPATIBLE AND
13 MANAGEABLE USING ELECTRONIC DATA PROCESSING ACCORDING TO DATA
14 SUBMISSION SCHEDULES, SUCH SCHEDULES TO AVOID, TO THE EXTENT
15 POSSIBLE, SUBMISSION OF IDENTICAL DATA FROM MORE THAN ONE
16 DATA SOURCE, ESTABLISHED AND PROMULGATED BY THE COUNCIL IN
17 REGULATIONS PURSUANT TO ITS AUTHORITY UNDER SECTION 5(B). IF
18 PAYOR DATA IS REQUESTED BY THE COUNCIL, IT SHALL, TO THE
19 EXTENT POSSIBLE, BE OBTAINED FROM PRIMARY PAYOR SOURCES.
20 (2) WITHIN 90 DAYS OF THE EFFECTIVE DATE OF THIS
21 PARAGRAPH, THE COUNCIL SHALL PUBLISH IN THE PENNSYLVANIA
22 BULLETIN A LIST OF DISEASES OR MEDICAL CONDITIONS, NOT TO
23 EXCEED 75, FOR WHICH DATA REQUIRED UNDER SUBSECTION (D) AND
24 FORMER SECTION 21(C) SHALL BE NULL AND VOID FOR ANY DISEASES
25 OR MEDICAL CONDITIONS NOT CONTAINED ON THE LIST. ALL OTHER
26 DATA ELEMENTS SHALL CONTINUE TO BE REQUIRED FROM DATA
27 SOURCES. THE COUNCIL SHALL REVIEW THIS LIST AT LEAST ONCE
28 ANNUALLY AND, NOT MORE THAN ONCE ANNUALLY, MAY ADJUST THE
29 NUMBER OF DISEASES OR MEDICAL CONDITIONS ON THE LIST BASE
30 UPON THE RECOMMENDATION OF ITS TECHNICAL ADVISORY GROUP.
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1 * * *
2 (D) [PROVIDER QUALITY] QUALITY AND [PROVIDER] SERVICE
3 EFFECTIVENESS DATA ELEMENTS.--[IN CARRYING OUT ITS DUTY TO
4 COLLECT DATA ON PROVIDER QUALITY AND PROVIDER SERVICE
5 EFFECTIVENESS UNDER SECTION 5(D)(4) AND SUBSECTION (C)(21), THE
6 COUNCIL SHALL DEFINE A METHODOLOGY TO MEASURE PROVIDER SERVICE
7 EFFECTIVENESS WHICH MAY INCLUDE ADDITIONAL DATA ELEMENTS TO BE
8 SPECIFIED BY THE COUNCIL SUFFICIENT TO CARRY OUT ITS
9 RESPONSIBILITIES UNDER SECTION 5(D)(4). THE COUNCIL MAY ADOPT A
10 NATIONALLY RECOGNIZED METHODOLOGY OF QUANTIFYING AND COLLECTING
11 DATA ON PROVIDER QUALITY AND PROVIDER SERVICE EFFECTIVENESS
12 UNTIL SUCH TIME AS THE COUNCIL HAS THE CAPABILITY OF DEVELOPING
13 ITS OWN METHODOLOGY AND STANDARD DATA ELEMENTS. THE COUNCIL
14 SHALL INCLUDE IN THE PENNSYLVANIA UNIFORM CLAIMS AND BILLING
15 FORM A FIELD CONSISTING OF THE DATA ELEMENTS REQUIRED PURSUANT
16 TO SUBSECTION (C)(21) TO PROVIDE INFORMATION ON EACH PROVISION
17 OF COVERED SERVICES SUFFICIENT TO PERMIT ANALYSIS OF PROVIDER
18 QUALITY AND PROVIDER SERVICE EFFECTIVENESS WITHIN 180 DAYS OF
19 COMMENCEMENT OF ITS OPERATIONS PURSUANT TO SECTION 4.] IN
20 CARRYING OUT ITS RESPONSIBILITIES, THE COUNCIL MAY NOT REQUIRE
21 HEALTH CARE INSURERS TO REPORT ON ADDITIONAL DATA ELEMENTS THAT
22 ARE NOT REPORTED TO NATIONALLY RECOGNIZED ACCREDITING
23 ORGANIZATIONS OR TO THE DEPARTMENT OF HEALTH OR THE INSURANCE
24 DEPARTMENT IN QUARTERLY OR ANNUAL REPORTS. THE COUNCIL MAY NOT
25 REQUIRE REPORTING BY HEALTH CARE INSURERS IN DIFFERENT FORMATS
26 THAN ARE REQUIRED FOR REPORTING TO NATIONALLY RECOGNIZED
27 ACCREDITING ORGANIZATIONS OR ON QUARTERLY OR ANNUAL REPORTS
28 SUBMITTED TO THE DEPARTMENT OF HEALTH OR THE INSURANCE
29 DEPARTMENT AS REQUIRED BY REGULATIONS OF EITHER DEPARTMENT. THE
30 COUNCIL MAY ADOPT THE QUALITY FINDINGS AS REPORTED TO NATIONALLY
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1 RECOGNIZED ACCREDITING ORGANIZATIONS.
2 * * *
3 (F.1) REVIEW AND CORRECTION OF DATA.--THE COUNCIL SHALL
4 PROVIDE A PERIOD FOR DATA SOURCES TO REVIEW AND CORRECT THE DATA
5 SUBMITTED BY THEM UNDER SECTION 6 THAT THE COUNCIL INTENDS TO
6 PREPARE AND ISSUE IN REPORTS TO THE GENERAL ASSEMBLY, TO THE
7 GENERAL PUBLIC OR IN SPECIAL STUDIES AND REPORTS UNDER SECTION
8 11. WHEN CORRECTIONS ARE PROVIDED, THE COUNCIL SHALL CORRECT THE
9 APPROPRIATE DATA IN ITS DATA FILES AND SUBSEQUENT REPORTS.
10 * * *
11 SECTION 3. SECTIONS 7(A), 10(B)(5) AND 12(B) OF THE ACT ARE
12 AMENDED TO READ:
13 SECTION 7. DATA DISSEMINATION AND PUBLICATION.
14 [(A) PUBLIC REPORTS.--SUBJECT TO THE RESTRICTIONS ON ACCESS
15 TO COUNCIL DATA SET FORTH IN SECTION 10 AND UTILIZING THE DATA
16 COLLECTED UNDER SECTION 6 AS WELL AS OTHER DATA, RECORDS AND
17 MATTERS OF RECORD AVAILABLE TO IT, THE COUNCIL SHALL PREPARE AND
18 ISSUE REPORTS TO THE GENERAL ASSEMBLY AND TO THE GENERAL PUBLIC,
19 ACCORDING TO THE FOLLOWING PROVISIONS:
20 (1) THE COUNCIL SHALL, FOR EVERY PROVIDER WITHIN THE
21 COMMONWEALTH AND WITHIN APPROPRIATE REGIONS AND SUBREGIONS
22 WITHIN THE COMMONWEALTH AND FOR THOSE INPATIENT AND
23 OUTPATIENT SERVICES WHICH, WHEN RANKED BY ORDER OF FREQUENCY,
24 ACCOUNT FOR AT LEAST 65% OF ALL COVERED SERVICES AND WHICH,
25 WHEN RANKED BY ORDER OF TOTAL PAYMENTS, ACCOUNT FOR AT LEAST
26 65% OF TOTAL PAYMENTS, PREPARE AND ISSUE REPORTS THAT AT
27 LEAST PROVIDE INFORMATION ON THE FOLLOWING:
28 (I) COMPARISONS AMONG ALL PROVIDERS OF PAYMENTS
29 RECEIVED, CHARGES, POPULATION-BASED ADMISSION OR
30 INCIDENCE RATES, AND PROVIDER SERVICE EFFECTIVENESS, SUCH
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1 COMPARISONS TO BE GROUPED ACCORDING TO DIAGNOSIS AND
2 SEVERITY, AND TO IDENTIFY EACH PROVIDER BY NAME AND TYPE
3 OR SPECIALTY.
4 (II) COMPARISONS AMONG ALL PROVIDERS, EXCEPT
5 PHYSICIANS, OF INPATIENT AND OUTPATIENT CHARGES AND
6 PAYMENTS FOR ROOM AND BOARD, ANCILLARY SERVICES, DRUGS,
7 EQUIPMENT AND SUPPLIES AND TOTAL SERVICES, SUCH
8 COMPARISONS TO BE GROUPED ACCORDING TO PROVIDER QUALITY
9 AND PROVIDER SERVICE EFFECTIVENESS AND ACCORDING TO
10 DIAGNOSIS AND SEVERITY, AND TO IDENTIFY EACH HEALTH CARE
11 FACILITY BY NAME AND TYPE.
12 (III) UNTIL AND UNLESS A METHODOLOGY TO MEASURE
13 PROVIDER QUALITY AND PROVIDER SERVICE EFFECTIVENESS
14 PURSUANT TO SECTIONS 5(D)(4) AND 6(C) AND (D) IS
15 AVAILABLE TO THE COUNCIL, COMPARISONS AMONG ALL
16 PROVIDERS, GROUPED ACCORDING TO DIAGNOSIS, PROCEDURE AND
17 SEVERITY, WHICH IDENTIFY FACILITIES BY NAME AND TYPE AND
18 PHYSICIANS BY NAME AND SPECIALTY, OF CHARGES AND PAYMENTS
19 RECEIVED, READMISSION RATES, MORTALITY RATES, MORBIDITY
20 RATES AND INFECTION RATES. FOLLOWING ADOPTION OF THE
21 METHODOLOGY SPECIFIED IN SECTIONS 5(D)(4) AND 6(C) AND
22 (D), THE COUNCIL MAY, AT ITS DISCRETION, DISCONTINUE
23 PUBLICATION OF THIS COMPONENT OF THE REPORT.
24 (IV) THE INCIDENCE RATE OF SELECTED MEDICAL OR
25 SURGICAL PROCEDURES, THE PROVIDER SERVICE EFFECTIVENESS
26 AND THE PAYMENTS RECEIVED FOR THOSE PROVIDERS, IDENTIFIED
27 BY THE NAME AND TYPE OR SPECIALTY, FOR WHICH THESE
28 ELEMENTS VARY SIGNIFICANTLY FROM THE NORMS FOR ALL
29 PROVIDERS.
30 (2) IN PREPARING ITS REPORTS UNDER PARAGRAPH (1), THE
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1 COUNCIL SHALL ENSURE THAT FACTORS WHICH HAVE THE EFFECT OF
2 EITHER REDUCING PROVIDER REVENUE OR INCREASING PROVIDER
3 COSTS, AND OTHER FACTORS BEYOND A PROVIDER'S CONTROL WHICH
4 REDUCE PROVIDER COMPETITIVENESS IN THE MARKET PLACE, ARE
5 EXPLAINED IN THE REPORTS. IT SHALL ALSO ENSURE THAT ANY
6 CLARIFICATIONS AND DISSENTS SUBMITTED BY INDIVIDUAL PROVIDERS
7 UNDER SECTION 6(G) ARE NOTED IN ANY REPORTS THAT INCLUDE
8 RELEASE OF DATA ON THAT INDIVIDUAL PROVIDER.
9 (3) THE COUNCIL SHALL, FOR ALL PROVIDERS WITHIN THE
10 COMMONWEALTH AND WITHIN APPROPRIATE REGIONS AND SUBREGIONS
11 WITHIN THE COMMONWEALTH, PREPARE AND ISSUE QUARTERLY REPORTS
12 THAT AT LEAST PROVIDE INFORMATION ON THE NUMBER OF
13 PHYSICIANS, BY SPECIALITY, ON THE STAFF OF EACH HOSPITAL OR
14 AMBULATORY SERVICE FACILITY AND THOSE PHYSICIANS ON THE STAFF
15 THAT ACCEPT MEDICARE ASSIGNMENT AS FULL PAYMENT AND THAT
16 ACCEPT MEDICAL ASSISTANCE PATIENTS.
17 (4) THE COUNCIL SHALL PUBLISH ALL REPORTS REQUIRED IN
18 THIS SECTION IN THE PENNSYLVANIA BULLETIN AND SHALL PUBLISH,
19 IN AT LEAST ONE NEWSPAPER OF GENERAL CIRCULATION IN EACH
20 SUBREGION WITHIN THE COMMONWEALTH, REPORTS ON THE PROVIDERS
21 IN THAT SUBREGION AND SUBREGIONS ADJACENT TO IT. IN ADDITION,
22 THE COUNCIL SHALL ADVERTISE ANNUALLY THE AVAILABILITY OF
23 THESE REPORTS AND THE CHARGE FOR DUPLICATION IN THE
24 PENNSYLVANIA BULLETIN AND IN AT LEAST ONE NEWSPAPER OF
25 GENERAL CIRCULATION IN EACH SUBREGION WITHIN THE COMMONWEALTH
26 AT LEAST ONCE IN EACH CALENDAR QUARTER.]
27 (A) PUBLIC REPORTS.--SUBJECT TO THE RESTRICTIONS ON ACCESS
28 TO COUNCIL DATA SET FORTH IN SECTION 10 AND UTILIZING THE DATA
29 COLLECTED UNDER SECTION 6 AS WELL AS OTHER DATA, RECORDS AND
30 MATTERS OF RECORD AVAILABLE TO IT, THE COUNCIL SHALL PREPARE AND
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1 ISSUE REPORTS TO THE GENERAL ASSEMBLY AND TO THE GENERAL PUBLIC,
2 ACCORDING TO THE FOLLOWING PROVISIONS:
3 (1) THE COUNCIL SHALL, FOR EVERY PROVIDER OF BOTH
4 INPATIENT AND OUTPATIENT SERVICES WITHIN THIS COMMONWEALTH
5 AND WITHIN APPROPRIATE REGIONS AND SUBREGIONS, PREPARE AND
6 ISSUE REPORTS ON PROVIDER QUALITY AND EFFECTIVENESS ON
7 DISEASES OR PROCEDURES THAT, WHEN RANKED BY VOLUME, COST,
8 PAYMENT AND HIGH VARIATION IN OUTCOME, REPRESENT THE BEST
9 OPPORTUNITY TO IMPROVE OVERALL PROVIDER QUALITY, IMPROVE
10 PATIENT SAFETY AND PROVIDE OPPORTUNITIES FOR COST REDUCTION.
11 THESE REPORTS SHALL PROVIDE COMPARATIVE INFORMATION ON THE
12 FOLLOWING:
13 (I) DIFFERENCES IN MORTALITY RATES; DIFFERENCES IN
14 LENGTH OF STAY; DIFFERENCES IN COMPLICATION RATES;
15 DIFFERENCES IN READMISSION RATES; DIFFERENCES IN
16 INFECTION RATES; AND OTHER COMPARATIVE OUTCOME MEASURES
17 THE COUNCIL MAY DEVELOP THAT WILL ALLOW PURCHASERS,
18 PROVIDERS AND CONSUMERS TO MAKE PURCHASING AND QUALITY
19 IMPROVEMENT DECISIONS BASED UPON QUALITY PATIENT CARE AND
20 TO RESTRAIN COSTS.
21 (II) THE INCIDENCE RATE OF SELECTED MEDICAL OR
22 SURGICAL PROCEDURES, THE PROVIDER SERVICE EFFECTIVENESS
23 AND THE PAYMENTS RECEIVED FOR THOSE PROVIDERS, IDENTIFIED
24 BY THE NAME AND TYPE OR SPECIALTY, FOR WHICH THESE
25 ELEMENTS VARY SIGNIFICANTLY FROM THE NORMS FOR ALL
26 PROVIDERS.
27 (2) IN PREPARING ITS REPORTS UNDER PARAGRAPH (1), THE
28 COUNCIL SHALL ENSURE THAT FACTORS WHICH HAVE THE EFFECT OF
29 EITHER REDUCING PROVIDER REVENUE OR INCREASING PROVIDER COSTS
30 AND OTHER FACTORS BEYOND A PROVIDER'S CONTROL WHICH REDUCE
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1 PROVIDER COMPETITIVENESS IN THE MARKETPLACE ARE EXPLAINED IN
2 THE REPORTS. THE COUNCIL SHALL ALSO ENSURE THAT ANY
3 CLARIFICATIONS AND DISSENTS SUBMITTED BY INDIVIDUAL PROVIDERS
4 UNDER SECTION 6(G) ARE NOTED IN ANY REPORTS THAT INCLUDE
5 RELEASE OF DATA ON THAT INDIVIDUAL PROVIDER.
6 * * *
7 SECTION 10. ACCESS TO COUNCIL DATA.
8 * * *
9 (B) LIMITATIONS ON ACCESS.--UNLESS SPECIFICALLY PROVIDED FOR
10 IN THIS ACT, NEITHER THE COUNCIL NOR ANY CONTRACTING SYSTEM
11 VENDOR SHALL RELEASE AND NO DATA SOURCE, PERSON, MEMBER OF THE
12 PUBLIC OR OTHER USER OF ANY DATA OF THE COUNCIL SHALL GAIN
13 ACCESS TO:
14 * * *
15 (5) ANY RAW DATA DISCLOSING DISCOUNTS OR DIFFERENTIALS
16 BETWEEN PAYMENTS ACCEPTED BY PROVIDERS FOR SERVICES AND THEIR
17 BILLED CHARGES OBTAINED BY IDENTIFIED PAYORS FROM IDENTIFIED
18 PROVIDERS [UNLESS COMPARABLE DATA ON ALL OTHER PAYORS IS ALSO
19 RELEASED AND THE COUNCIL DETERMINES THAT THE RELEASE OF SUCH
20 INFORMATION IS NOT PREJUDICIAL OR INEQUITABLE TO ANY
21 INDIVIDUAL PAYOR OR PROVIDER OR GROUP THEREOF. IN MAKING SUCH
22 DETERMINATION THE COUNCIL SHALL CONSIDER THAT IT IS PRIMARILY
23 CONCERNED WITH THE ANALYSIS AND DISSEMINATION OF PAYMENTS TO
24 PROVIDERS, NOT WITH DISCOUNTS].
25 * * *
26 SECTION 12. ENFORCEMENT; PENALTY.
27 * * *
28 (B) PENALTY.--
29 (1) ANY PERSON WHO FAILS TO SUPPLY DATA PURSUANT TO
30 SECTION 6 [COMMITS A MISDEMEANOR OF THE THIRD DEGREE AND
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1 SHALL, UPON CONVICTION, BE SENTENCED TO PAY A FINE NOT TO
2 EXCEED $1,000. EACH DAY ON WHICH THE REQUIRED DATA IS NOT
3 SUBMITTED CONSTITUTES A SEPARATE OFFENSE UNDER THIS
4 PARAGRAPH.] MAY BE ASSESSED A CIVIL PENALTY NOT TO EXCEED
5 $1,000 FOR EACH DAY THE DATA IS NOT SUBMITTED.
6 (2) ANY PERSON WHO[, AFTER BEING SENTENCED UNDER
7 PARAGRAPH (1), FAILS TO SUPPLY DATA] KNOWINGLY SUBMITS
8 INACCURATE DATA PURSUANT TO SECTION 6 COMMITS A MISDEMEANOR
9 OF THE THIRD DEGREE AND SHALL, UPON CONVICTION, BE SENTENCED
10 TO PAY A FINE OF $10,000 OR TO IMPRISONMENT FOR NOT MORE THAN
11 FIVE YEARS, OR BOTH.
12 SECTION 4. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
13 SECTION 17.2. LEGISLATIVE BUDGET AND FINANCE COMMITTEE REPORT.
14 (A) GENERAL RULE.--BY DECEMBER 31, 2006, THE LEGISLATIVE
15 BUDGET AND FINANCE COMMITTEE SHALL COMPLETE A WRITTEN REPORT
16 EVALUATING THE MANAGEMENT, PERFORMANCE, VISIBILITY, AWARENESS
17 AND PERFORMANCE OF THE COUNCIL AND SHALL SUBMIT THE REPORT TO
18 THE PUBLIC HEALTH AND WELFARE COMMITTEE OF THE SENATE AND THE
19 HEALTH AND HUMAN SERVICES COMMITTEE OF THE HOUSE OF
20 REPRESENTATIVES. THE REPORT SHALL DETERMINE WHETHER THE COUNCIL
21 IS:
22 (1) CONDUCTING AUTHORIZED ACTIVITIES IN A MANNER
23 CONSISTENT WITH ACCOMPLISHING THE OBJECTIVES INTENDED BY THE
24 GENERAL ASSEMBLY.
25 (2) CONDUCTING ACTIVITIES AND EXPENDING FUNDS MADE
26 AVAILABLE IN A FAITHFUL, EFFICIENT, ECONOMICAL AND EFFECTIVE
27 MANNER.
28 (B) CONTENTS OF REPORT.--THE REPORT SHALL INCLUDE, BUT NOT
29 BE LIMITED TO, DISCUSSION OF THE FOLLOWING CRITERIA:
30 (1) WHETHER THERE IS OVERLAP OR DUPLICATION OF EFFORT BY
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1 OTHER AGENCIES.
2 (2) WHETHER THERE IS A MORE ECONOMICAL WAY OF
3 ACCOMPLISHING THE OBJECTIVES OF THE COUNCIL.
4 (3) WHETHER THERE IS A DEMONSTRATED NEED, BASED ON
5 SERVICE TO THE PUBLIC, FOR THE CONTINUING EXISTENCE OF THE
6 COUNCIL.
7 (4) WHETHER THE OPERATION OF THE COUNCIL HAS BEEN IN THE
8 PUBLIC INTEREST.
9 (5) WHETHER THE COUNCIL HAS ENCOURAGED PUBLIC
10 PARTICIPATION IN THE MAKING OF ITS RULES AND DECISIONS OR
11 WHETHER THE COUNCIL HAS PERMITTED PARTICIPATION SOLELY BY THE
12 PERSONS ITS REGULATES.
13 (6) WHETHER THERE IS AN ALTERNATE, LESS RESTRICTIVE
14 METHOD OF PROVIDING THE SAME SERVICES TO THE PUBLIC.
15 (7) SUCH OTHER CRITERIA AS MAY BE ESTABLISHED BY THE
16 STANDING COMMITTEES.
17 SECTION 5. SECTION 19 OF THE ACT IS AMENDED TO READ:
18 SECTION 19. SUNSET.
19 THIS ACT SHALL EXPIRE JUNE 30, [2003] 2009, UNLESS REENACTED
20 PRIOR TO [THAT DATE] DECEMBER 31, 2008.
21 SECTION 6. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
22 (1) THE AMENDMENT OF SECTION 19 OF THE ACT SHALL TAKE
23 EFFECT IMMEDIATELY.
24 (2) THIS SECTION SHALL TAKE EFFECT IMMEDIATELY.
25 (3) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT IN 60
26 DAYS.
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