PRIOR PRINTER'S NOS. 398, 955, 969, PRINTER'S NO. 1076
1040, 1045
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
SENATE AMENDMENTS TO HOUSE AMENDMENTS, JULY 8, 2003
AN ACT
1 Reenacting and amending the act of July 8, 1986 (P.L.408,
2 No.89), entitled, as reenacted and amended, "An act providing
3 for the creation of the Health Care Cost Containment Council,
4 for its powers and duties, for health care cost containment
5 through the 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," further providing
8 for the Health Care Cost Containment Council, for powers and
9 duties of the council, for data submission and collection,
10 for data dissemination, for mandated health benefits, for
11 access to council data, for enforcement and penalty and for
12 expiration; and providing for penalties. <--
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. The title and sections 1, 2 and 3 of the act of
16 July 8, 1986 (P.L.408, No.89), known as the Health Care Cost
17 Containment Act, reenacted and amended June 28, 1993 (P.L.146,
18 No.34), are reenacted to read:
19 AN ACT
20 Providing for the creation of the Health Care Cost Containment
21 Council, for its powers and duties, for health care cost
1 containment through the collection and dissemination of data,
2 for public accountability of health care costs and for health
3 care for the indigent; and making an appropriation.
4 Section 1. Short title.
5 This act shall be known and may be cited as the Health Care
6 Cost Containment Act.
7 Section 2. Legislative finding and declaration.
8 The General Assembly finds that there exists in this
9 Commonwealth a major crisis because of the continuing escalation
10 of costs for health care services. Because of the continuing
11 escalation of costs, an increasingly large number of
12 Pennsylvania citizens have severely limited access to
13 appropriate and timely health care. Increasing costs are also
14 undermining the quality of health care services currently being
15 provided. Further, the continuing escalation is negatively
16 affecting the economy of this Commonwealth, is restricting new
17 economic growth and is impeding the creation of new job
18 opportunities in this Commonwealth.
19 The continuing escalation of health care costs is
20 attributable to a number of interrelated causes, including:
21 (1) Inefficiency in the present configuration of health
22 care service systems and in their operation.
23 (2) The present system of health care cost payments by
24 third parties.
25 (3) The increasing burden of indigent care which
26 encourages cost shifting.
27 (4) The absence of a concentrated and continuous effort
28 in all segments of the health care industry to contain health
29 care costs.
30 Therefore, it is hereby declared to be the policy of the
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1 Commonwealth of Pennsylvania to promote health care cost
2 containment and to identify appropriate utilization practices by
3 creating an independent council to be known as the Health Care
4 Cost Containment Council.
5 It is the purpose of this legislation to promote the public
6 interest by encouraging the development of competitive health
7 care services in which health care costs are contained and to
8 assure that all citizens have reasonable access to quality
9 health care.
10 It is further the intent of this act to facilitate the
11 continuing provision of quality, cost-effective health services
12 throughout the Commonwealth by providing current, accurate data
13 and information to the purchasers and consumers of health care
14 on both cost and quality of health care services and to public
15 officials for the purpose of determining health-related programs
16 and policies and to assure access to health care services.
17 Nothing in this act shall prohibit a purchaser from obtaining
18 from its third-party insurer, carrier or administrator, nor
19 relieve said third-party insurer, carrier or administrator from
20 the obligation of providing, on terms consistent with past
21 practices, data previously provided to a purchaser pursuant to
22 any existing or future arrangement, agreement or understanding.
23 Section 3. Definitions.
24 The following words and phrases when used in this act shall
25 have the meanings given to them in this section unless the
26 context clearly indicates otherwise:
27 "Ambulatory service facility." A facility licensed in this
28 Commonwealth, not part of a hospital, which provides medical,
29 diagnostic or surgical treatment to patients not requiring
30 hospitalization, including ambulatory surgical facilities,
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1 ambulatory imaging or diagnostic centers, birthing centers,
2 freestanding emergency rooms and any other facilities providing
3 ambulatory care which charge a separate facility charge. This
4 term does not include the offices of private physicians or
5 dentists, whether for individual or group practices.
6 "Charge" or "rate." The amount billed by a provider for
7 specific goods or services provided to a patient, prior to any
8 adjustment for contractual allowances.
9 "Council." The Health Care Cost Containment Council.
10 "Covered services." Any health care services or procedures
11 connected with episodes of illness that require either inpatient
12 hospital care or major ambulatory service such as surgical,
13 medical or major radiological procedures, including any initial
14 and follow-up outpatient services associated with the episode of
15 illness before, during or after inpatient hospital care or major
16 ambulatory service. The term does not include routine outpatient
17 services connected with episodes of illness that do not require
18 hospitalization or major ambulatory service.
19 "Data source." A hospital; ambulatory service facility;
20 physician; health maintenance organization as defined in the act
21 of December 29, 1972 (P.L.1701, No.364), known as the Health
22 Maintenance Organization Act; hospital, medical or health
23 service plan with a certificate of authority issued by the
24 Insurance Department, including, but not limited to, hospital
25 plan corporations as defined in 40 Pa.C.S. Ch. 61 (relating to
26 hospital plan corporations) and professional health services
27 plan corporations as defined in 40 Pa.C.S. Ch. 63 (relating to
28 professional health services plan corporations); commercial
29 insurer with a certificate of authority issued by the Insurance
30 Department providing health or accident insurance; self-insured
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1 employer providing health or accident coverage or benefits for
2 employees employed in the Commonwealth; administrator of a self-
3 insured or partially self-insured health or accident plan
4 providing covered services in the Commonwealth; any health and
5 welfare fund that provides health or accident benefits or
6 insurance pertaining to covered service in the Commonwealth; the
7 Department of Public Welfare for those covered services it
8 purchases or provides through the medical assistance program
9 under the act of June 13, 1967 (P.L.31, No.21), known as the
10 Public Welfare Code, and any other payor for covered services in
11 the Commonwealth other than an individual.
12 "Health care facility." A general or special hospital,
13 including tuberculosis and psychiatric hospitals, kidney disease
14 treatment centers, including freestanding hemodialysis units,
15 and ambulatory service facilities as defined in this section,
16 and hospices, both profit and nonprofit, and including those
17 operated by an agency of State or local government.
18 "Health care insurer." Any person, corporation or other
19 entity that offers administrative, indemnity or payment services
20 for health care in exchange for a premium or service charge
21 under a program of health care benefits, including, but not
22 limited to, an insurance company, association or exchange
23 issuing health insurance policies in this Commonwealth; hospital
24 plan corporation as defined in 40 Pa.C.S. Ch. 61 (relating to
25 hospital plan corporations); professional health services plan
26 corporation as defined in 40 Pa.C.S. Ch. 63 (relating to
27 professional health services plan corporations); health
28 maintenance organization; preferred provider organization;
29 fraternal benefit societies; beneficial societies; and third-
30 party administrators; but excluding employers, labor unions or
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1 health and welfare funds jointly or separately administered by
2 employers or labor unions that purchase or self-fund a program
3 of health care benefits for their employees or members and their
4 dependents.
5 "Health maintenance organization." An organized system which
6 combines the delivery and financing of health care and which
7 provides basic health services to voluntarily enrolled
8 subscribers for a fixed prepaid fee, as defined in the act of
9 December 29, 1972 (P.L.1701, No.364), known as the Health
10 Maintenance Organization Act.
11 "Hospital." An institution, licensed in this Commonwealth,
12 which is a general, tuberculosis, mental, chronic disease or
13 other type of hospital, or kidney disease treatment center,
14 whether profit or nonprofit, and including those operated by an
15 agency of State or local government.
16 "Indigent care." The actual costs, as determined by the
17 council, for the provision of appropriate health care, on an
18 inpatient or outpatient basis, given to individuals who cannot
19 pay for their care because they are above the medical assistance
20 eligibility levels and have no health insurance or other
21 financial resources which can cover their health care.
22 "Major ambulatory service." Surgical or medical procedures,
23 including diagnostic and therapeutic radiological procedures,
24 commonly performed in hospitals or ambulatory service
25 facilities, which are not of a type commonly performed or which
26 cannot be safely performed in physicians' offices and which
27 require special facilities such as operating rooms or suites or
28 special equipment such as fluoroscopic equipment or computed
29 tomographic scanners, or a postprocedure recovery room or short-
30 term convalescent room.
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1 "Medical procedure incidence variations." The variation in
2 the incidence in the population of specific medical, surgical
3 and radiological procedures in any given year, expressed as a
4 deviation from the norm, as these terms are defined in the
5 classical statistical definition of "variation," "incidence,"
6 "deviation" and "norm."
7 "Medically indigent" or "indigent." The status of a person
8 as described in the definition of indigent care.
9 "Payment." The payments that providers actually accept for
10 their services, exclusive of charity care, rather than the
11 charges they bill.
12 "Payor." Any person or entity, including, but not limited
13 to, health care insurers and purchasers, that make direct
14 payments to providers for covered services.
15 "Physician." An individual licensed under the laws of this
16 Commonwealth to practice medicine and surgery within the scope
17 of the act of October 5, 1978 (P.L.1109, No.261), known as the
18 Osteopathic Medical Practice Act, or the act of December 20,
19 1985 (P.L.457, No.112), known as the Medical Practice Act of
20 1985.
21 "Preferred provider organization." Any arrangement between a
22 health care insurer and providers of health care services which
23 specifies rates of payment to such providers which differ from
24 their usual and customary charges to the general public and
25 which encourage enrollees to receive health services from such
26 providers.
27 "Provider." A hospital, an ambulatory service facility or a
28 physician.
29 "Provider quality." The extent to which a provider renders
30 care that, within the capabilities of modern medicine, obtains
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1 for patients medically acceptable health outcomes and prognoses,
2 adjusted for patient severity, and treats patients
3 compassionately and responsively.
4 "Provider service effectiveness." The effectiveness of
5 services rendered by a provider, determined by measurement of
6 the medical outcome of patients grouped by severity receiving
7 those services.
8 "Purchaser." All corporations, labor organizations and other
9 entities that purchase benefits which provide covered services
10 for their employees or members, either through a health care
11 insurer or by means of a self-funded program of benefits, and a
12 certified bargaining representative that represents a group or
13 groups of employees for whom employers purchase a program of
14 benefits which provide covered services, but excluding entities
15 defined in this section as "health care insurers."
16 "Raw data" or "data." Data collected by the council under
17 section 6 in the form initially received. No data shall be
18 released by the council except as provided for in section 11.
19 "Severity." In any patient, the measureable degree of the
20 potential for failure of one or more vital organs.
21 Section 2. Sections 4, 5, 6 and 7 of the act are reenacted
22 and amended to read:
23 Section 4. Health Care Cost Containment Council.
24 (a) Establishment.--The General Assembly hereby establishes
25 an independent council to be known as the Health Care Cost
26 Containment Council.
27 (b) Composition.--The council shall consist of [21] voting
28 members, composed of and appointed in accordance with the
29 following:
30 (1) The Secretary of Health.
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1 (2) The Secretary of Public Welfare.
2 (3) The Insurance Commissioner.
3 (3.1) Four members of the General Assembly, which shall <--
4 consist of the chairman and minority chairman of the Public
5 Health and Welfare Committee of the Senate and the chairman
6 and minority chairman of the Health and Human Services
7 Committee of the House of Representatives. Members under this
8 paragraph may appoint a designee to act on behalf of the
9 member at meetings of the council and of committees, as
10 provided in subsection (f). Designees shall be counted for
11 purposes of determining a quorum.
12 (4) Six representatives of the business community, at
13 least one of whom represents small business, who are
14 purchasers of health care as defined in section 3, none of
15 which is primarily involved in the provision of health care
16 or health insurance, three of which shall be appointed by the
17 President pro tempore of the Senate and three of which shall
18 be appointed by the Speaker of the House of Representatives
19 from a list of twelve qualified persons recommended by the
20 Pennsylvania Chamber of Business and Industry. Three nominees
21 shall be representatives of small business.
22 (5) Six representatives of organized labor, three of
23 which shall be appointed by the President pro tempore of the
24 Senate and three of which shall be appointed by the Speaker
25 of the House of Representatives from a list of twelve
26 qualified persons recommended by the Pennsylvania AFL-CIO.
27 (6) One representative of consumers who is not primarily
28 involved in the provision of health care or health care
29 insurance, appointed by the Governor from a list of three
30 qualified persons recommended jointly by the Speaker of the
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1 House of Representatives and the President pro tempore of the
2 Senate.
3 (6.1) One representative of patient advocacy groups <--
4 appointed by the Governor, who must be an employee of a not-
5 for-profit patient safety advocacy organization.
6 (7) [One representative] Three TWO representatives of <--
7 hospitals, appointed by the Governor from a list of [three]
8 five qualified hospital representatives recommended by the
9 Hospital and Health System Association of Pennsylvania ONE OF <--
10 WHOM SHALL BE A REPRESENTATIVE OF RURAL HOSPITALS.
11 Representatives under this paragraph shall include one <--
12 representative of academic teaching hospitals and one
13 representative of rural hospitals. [The] Each representative
14 under this paragraph may appoint two additional delegates to
15 act for the representative only at meetings of committees, as
16 provided for in subsection (f).
17 (8) [One representative] Two representatives of
18 physicians, appointed by the Governor from a list of [three] <--
19 FIVE qualified physician representatives recommended jointly <--
20 by the Pennsylvania Medical Society and the Pennsylvania
21 Osteopathic Medical Society. The representative under this
22 paragraph may appoint two additional delegates to act for the
23 representative only at meetings of committees, as provided
24 for in subsection (f).
25 (8.1) An individual appointed by the Governor who is <--
26 certified in continuous quality improvement methods. HAS <--
27 EXPERTISE IN THE APPLICATION OF CONTINUOUS QUALITY
28 IMPROVEMENT METHODS IN HOSPITALS.
29 (8.2) One representative of nurses, appointed by the
30 Governor from a list of three qualified representatives
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1 recommended by the Pennsylvania State Nurses Association.
2 (9) One representative of the Blue Cross and Blue Shield
3 plans in Pennsylvania, appointed by the Governor from a list
4 of three qualified persons recommended jointly by the Blue
5 Cross and Blue Shield plans of Pennsylvania.
6 (10) One representative of commercial insurance
7 carriers, appointed by the Governor from a list of three
8 qualified persons recommended by the Insurance Federation of
9 Pennsylvania, Inc.
10 (11) One representative of health maintenance
11 organizations, appointed by the Governor from a list of three
12 qualified persons recommended by the [Pennsylvania
13 Association of Health Maintenance Organizations] Managed Care
14 Association of Pennsylvania.
15 (12) In the case of each appointment to be made from a
16 list supplied by a specified organization, it is incumbent
17 upon that organization to consult with and provide a list
18 which reflects the input of other equivalent organizations
19 representing similar interests. Each appointing authority
20 will have the discretion to request additions to the list
21 originally submitted. Additional names will be provided not
22 later than 15 days after such request. Appointments shall be
23 made by the appointing authority no later than 90 days after
24 receipt of the original list. If, for any reason, any
25 specified organization supplying a list should cease to
26 exist, then the respective appointing authority shall specify
27 a new equivalent organization to fulfill the responsibilities
28 of this act.
29 (c) Chairperson and vice chairperson.--The members shall
30 annually elect, by a majority vote of the members, a chairperson
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1 and a vice chairperson of the council from among the business
2 and labor representatives on the council.
3 (d) Quorum.--[Eleven] Seventeen THIRTEEN members, [a <--
4 majority of which in any combination shall] at least six of whom
5 must be made up of representatives of business and labor, shall
6 constitute a quorum for the transaction of any business, and the
7 act by the majority of the members present at any meeting in
8 which there is a quorum shall be deemed to be the act of the
9 council.
10 (e) Meetings.--All meetings of the council shall be
11 advertised and conducted pursuant to [the act of July 3, 1986
12 (P.L.388, No.84), known as the Sunshine Act] 65 Pa.C.S. Ch. 7
13 (relating to open meetings), unless otherwise provided in this
14 section.
15 (1) The council shall meet at least once every two
16 months, and may provide for special meetings as it deems
17 necessary. Meeting dates shall be set by a majority vote of
18 the members of the council or by the call of the chairperson
19 upon seven days' notice to all council members.
20 (2) All meetings of the council shall be publicly
21 advertised, as provided for in this subsection, and shall be
22 open to the public, except that the council, through its
23 bylaws, may provide for executive sessions of the council on
24 subjects permitted to be discussed in such sessions under
25 [the Sunshine Act] 65 Pa.C.S. Ch. 7. No act of the council
26 shall be taken in an executive session.
27 (3) The council shall publish a schedule of its meetings
28 in the Pennsylvania Bulletin and in at least one newspaper in
29 general circulation in the Commonwealth. Such notice shall be
30 published at least once in each calendar quarter and shall
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1 list the schedule of meetings of the council to be held in
2 the subsequent calendar quarter. Such notice shall specify
3 the date, time and place of the meeting and shall state that
4 the council's meetings are open to the general public, except
5 that no such notice shall be required for executive sessions
6 of the council.
7 (4) All action taken by the council shall be taken in
8 open public session, and action of the council shall not be
9 taken except upon the affirmative vote of a majority of the
10 members of the council present during meetings at which a
11 quorum is present.
12 (f) Bylaws.--The council shall adopt bylaws, not
13 inconsistent with this act, and may appoint such committees or
14 elect such officers subordinate to those provided for in
15 subsection (c) as it deems advisable. The council shall provide
16 for the approval and participation of additional delegates
17 appointed under subsection (b)(7) and (8) so that each
18 organization represented by delegates under those paragraphs
19 shall not have more than one vote on any committee to which they
20 are appointed. The council shall also appoint a technical
21 advisory group which shall, on an ad hoc basis, respond to
22 issues presented to it by the council or committees of the
23 council and shall make recommendations to the council. The
24 technical advisory group shall include physicians, researchers
25 [and biostatisticians.], biostatisticians, one representative of
26 the Hospital and Healthsystem Association of Pennsylvania and
27 one representative of the Pennsylvania Medical Society. The
28 Hospital and Healthsystem Association of Pennsylvania and the
29 Pennsylvania Medical Society representatives shall not be
30 subject to executive committee approval. In appointing OTHER <--
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1 physicians, researchers and biostatisticians to the technical
2 advisory group, the council shall consult with and take
3 nominations from the representatives of the Hospital Association
4 of Pennsylvania, the Pennsylvania Medical Society, the
5 Pennsylvania Osteopathic Medical Society or other like
6 organizations. At its discretion and in accordance with this
7 section, nominations shall be approved by the executive
8 committee of the council. If the subject matter of any project
9 exceeds the expertise of the technical advisory group,
10 physicians in appropriate specialties who possess current
11 knowledge of the issue under study may be consulted. The
12 technical advisory group shall also review the availability and
13 reliability of severity of illness measurements as they relate
14 to small hospitals and psychiatric, rehabilitation and
15 children's hospitals and shall make recommendations to the
16 council based upon this review.
17 (g) Compensation and expenses.--The members of the council
18 shall not receive a salary or per diem allowance for serving as
19 members of the council but shall be reimbursed for actual and
20 necessary expenses incurred in the performance of their duties.
21 Said expenses may include reimbursement of travel and living
22 expenses while engaged in council business.
23 (h) Terms of council members.--
24 (1) The terms of the Secretary of Health, the Secretary
25 of Public Welfare and the Insurance Commissioner shall be
26 concurrent with their holding of public office. The [eighteen
27 appointed] council members under subsection (b)(1), (2), (3) <--
28 and (3.1) shall serve ex officio. The council members under
29 subsection (b)(4) through (11) shall each serve for a term of
30 [three] four years and shall continue to serve thereafter
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1 until their successor is appointed[, except that, of the <--
2 members first appointed:
3 (i) Two each of the representatives of business and
4 organized labor and the representative of consumers shall
5 serve for a term to expire on June 30 of the year
6 following their appointment.
7 (ii) Two each of the representatives of business and
8 organized labor and the representatives of the Blue Cross
9 and Blue Shield plans of Pennsylvania and the commercial
10 insurance carriers shall serve for a term to expire on
11 June 30 of the second year following their appointment.
12 (iii) Two each of the representatives of business
13 and organized labor and the representatives of hospitals,
14 physicians and health maintenance organizations shall
15 serve for a term to expire on June 30 of the third year
16 following their appointment]. <--
17 (2) Vacancies on the council shall be filled in the
18 [same] manner [in which they were originally] designated <--
19 under subsection (b), within 60 days of the vacancy, except
20 that when vacancies occur among the representatives of
21 business or organized labor, two nominations shall be
22 submitted by the organization specified in subsection (b) for
23 each vacancy on the council. If the officer required in
24 subsection (b) to make appointments to the council fails to
25 act within 60 days of the vacancy, the council chairperson
26 may appoint one of the persons recommended for the vacancy
27 until the appointing authority makes the appointment.
28 (3) A member may be removed for just cause by the
29 appointing authority after recommendation by a vote of at
30 least 14 members of the council.
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1 (4) No appointed member under subsection (b)(4) through
2 (11) shall be eligible to serve more than two full
3 consecutive terms of four years beginning on July 1, 2003 THE <--
4 EFFECTIVE DATE OF THIS PARAGRAPH.
5 [(i) Commencement of operations.-- <--
6 (1) Within 60 days after the effective date of this act,
7 each organization or individual required to submit a list of
8 recommended persons to the Governor, the President pro
9 tempore of the Senate or the Speaker of the House of
10 Representatives under subsection (b) shall submit said list.
11 (2) Within 90 days of the effective date of this act,
12 the Governor, the President pro tempore of the Senate and the
13 Speaker of the House of Representatives shall make all of the
14 appointments called for in subsection (b), and the council
15 shall begin operations immediately following these
16 appointments.] <--
17 (j) Subsequent appointments.--Submission of lists of
18 recommended persons and appointments of council members for [the <--
19 second and] succeeding terms shall be made in the same manner as <--
20 prescribed in subsection (b), except that:
21 (1) Organizations required under subsection (b) to
22 submit lists of recommended persons shall do so at least 60
23 days prior to expiration of the council members' terms.
24 (2) The officer required under subsection (b) to make
25 appointments to the council shall make said appointments at
26 least 30 days prior to expiration of the council members'
27 terms. If the appointments are not made within the specified
28 time, the council chairperson may make interim appointments
29 from the lists of recommended individuals. An interim
30 appointment shall be valid only until the appropriate officer
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1 under subsection (b) makes the required appointment. Whether
2 the appointment is by the required officer or by the
3 chairperson of the council, the appointment shall become
4 effective immediately upon expiration of the incumbent
5 member's term.
6 [(k) Appointments of acting councilors.--Should any <--
7 organization or individual fail to submit a list of recommended
8 persons as required under subsection (b) within the time limits
9 in subsection (i) or (j), the officer designated to make the
10 appointment under subsection (b) shall appoint as many acting
11 councilors as required under subsection (b) until such time as
12 the list of recommended persons is submitted by the original
13 organization as required in subsection (b).] <--
14 Section 5. Powers and duties of the council.
15 (a) General powers.--The council shall exercise all powers
16 necessary and appropriate to carry out its duties, including the
17 following:
18 (1) To employ an executive director, investigators and
19 other staff necessary to comply with the provisions of this
20 act and regulations promulgated thereunder, to employ or
21 retain legal counsel and to engage professional consultants,
22 as it deems necessary to the performance of its duties. Any
23 consultants, other than sole source consultants, engaged by
24 the council shall be selected in accordance with the
25 provisions for contracting with vendors set forth in section
26 16.
27 (2) To fix the compensation of all employees and to
28 prescribe their duties. Notwithstanding the independence of
29 the council under section 4(a), employees under this
30 paragraph shall be deemed employees of the Commonwealth for
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1 the purposes of participation in the Pennsylvania Employee
2 Benefit Trust Fund.
3 (3) To make and execute contracts and other instruments,
4 including those for purchase of services and purchase or
5 leasing of equipment and supplies, necessary or convenient to
6 the exercise of the powers of the council. Any such contract
7 shall be let only in accordance with the provision for
8 contracting with vendors set forth in section 16.
9 (4) To conduct examinations and investigations, to
10 conduct audits, pursuant to the provisions of subsection (c),
11 and to hear testimony and take proof, under oath or
12 affirmation, at public or private hearings, on any matter
13 necessary to its duties.
14 (4.1) To provide hospitals with individualized data on
15 adverse medical events, complications and hospital infections <--
16 PATIENT SAFETY INDICATORS PURSUANT TO SECTION 6(C)(7). The <--
17 data shall be risk adjusted and made available to hospitals
18 electronically and free of charge on a quarterly basis within
19 45 days of receipt of the corrected quarterly data from the
20 hospitals. The data is intended to provide the patient safety
21 committee of each hospital with information necessary to
22 assist it in conducting route cause PATIENT SAFETY analysis. <--
23 (5) To do all things necessary to carry out its duties
24 under the provisions of this act.
25 (b) Rules and regulations.--The council [may, in a manner
26 provided by law, promulgate rules and regulations] shall
27 promulgate rules and regulations in accordance with the act of
28 June 25, 1982 (P.L.633, No.181), known as the Regulatory Review
29 Act, necessary to carry out its duties under this act. This
30 subsection shall not apply to regulations in effect on June 30,
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1 2003.
2 (c) Audit powers.--The council shall have the right to
3 independently audit all information required to be submitted by
4 data sources as needed to corroborate the accuracy of the
5 submitted data, pursuant to the following:
6 (1) Audits of information submitted by providers or
7 health care insurers shall be performed on a sample and
8 issue-specific basis, as needed by the council, and shall be
9 coordinated, to the extent practicable, with audits performed
10 by the Commonwealth. All health care insurers and providers
11 are hereby required to make those books, records of accounts
12 and any other data needed by the auditors available to the
13 council at a convenient location within 30 days of a written
14 notification by the council.
15 (2) Audits of information submitted by purchasers shall
16 be performed on a sample basis, unless there exists
17 reasonable cause to audit specific purchasers, but in no case
18 shall the council have the power to audit financial
19 statements of purchasers.
20 (3) All audits performed by the council shall be
21 performed at the expense of the council.
22 (d) General duties and functions.--The council is hereby
23 authorized to and shall perform the following duties and
24 functions:
25 (1) Develop a computerized system for the collection,
26 analysis and dissemination of data. The council may contract
27 with a vendor who will provide such data processing services.
28 The council shall assure that the system will be capable of
29 processing all data required to be collected under this act.
30 Any vendor selected by the council shall be selected in
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1 accordance with the provisions of section 16, and said vendor
2 shall relinquish any and all proprietary rights or claims to
3 the data base created as a result of implementation of the
4 data processing system.
5 (2) Establish a Pennsylvania Uniform Claims and Billing
6 Form for all data sources and all providers which shall be
7 utilized and maintained by all data sources and all providers
8 for all services covered under this act.
9 (3) Collect and disseminate data, as specified in
10 section 6, and other information from data sources to which
11 the council is entitled, prepared according to formats, time
12 frames and confidentiality provisions as specified in
13 sections 6 and 10, and by the council.
14 (4) Adopt and implement a methodology to collect and
15 disseminate data reflecting provider quality and provider
16 service effectiveness pursuant to section 6 [and to
17 continuously study quality of care systems].
18 (5) Subject to the restrictions on access to raw data
19 set forth in section 10, issue special reports and make
20 available raw data as defined in section 3 to any purchaser
21 requesting it. Sale by any recipient or exchange or
22 publication by a recipient, other than a purchaser, of raw
23 council data to other parties without the express written
24 consent of, and under terms approved by, the council shall be
25 unauthorized use of data pursuant to section 10(c).
26 (6) On an annual basis, publish in the Pennsylvania
27 Bulletin a list of all the raw data reports it has prepared
28 under section 10(f) and a description of the data obtained
29 through each computer-to-computer access it has provided
30 under section 10(f) and of the names of the parties to whom
20030S0387B1076 - 20 -
1 the council provided the reports or the computer-to-computer
2 access during the previous month.
3 (7) Promote competition in the health care and health
4 insurance markets.
5 (8) Assure that the use of council data does not raise
6 access barriers to care.
7 (10) Make annual reports to the General Assembly on the
8 rate of increase in the cost of health care in the
9 Commonwealth and the effectiveness of the council in carrying
10 out the legislative intent of this act. In addition, the
11 council may make recommendations on the need for further
12 health care cost containment legislation. The council shall
13 also make annual reports to the General Assembly on the
14 quality and effectiveness of health care and access to health
15 care for all citizens of the Commonwealth.
16 [(11) Adopt, within one year, a model patient itemized
17 statement for all providers, which itemizes all charges for
18 services, equipment, supplies and medicine, designed to be
19 more understandable than current patient bills. Each provider
20 shall be required to utilize said model patient itemized
21 statement for covered services within 90 days of adoption of
22 said form by the council. Such model patient itemized
23 statements shall be written in language that is
24 understandable to the average person and be presented to each
25 patient upon discharge from a health care facility or
26 provision of patient services or within a reasonable time
27 thereafter. Patients may request a copy of their Pennsylvania
28 Uniform Claims and Billing Form, and, upon request, the
29 provider shall furnish this form to the patient within 30
30 days.]
20030S0387B1076 - 21 -
1 (12) Conduct studies and publish reports thereon
2 analyzing the effects that noninpatient, alternative health
3 care delivery systems have on health care costs. These
4 systems shall include, but not be limited to: HMO's; PPO's;
5 primary health care facilities; home health care; attendant
6 care; ambulatory service facilities; freestanding emergency
7 centers; birthing centers; and hospice care. These reports
8 shall be submitted to the General Assembly and shall be made
9 available to the public.
10 (13) Conduct studies and make reports concerning the
11 utilization of experimental and nonexperimental transplant
12 surgery and other highly technical and experimental
13 procedures, including costs and mortality rates.
14 (14) In order to insure ENSURE that the council adopts <--
15 and maintains both scientifically credible and cost-effective
16 methodology to collect and disseminate data reflecting
17 provider quality and effectiveness, the council shall, within
18 one year of the effective date of this paragraph, utilizing
19 current Commonwealth agency guidelines and procedures, issue
20 a request for information from any vendor that wishes to
21 provide data collection or risk adjustment methodology to the
22 council to help meet the requirements of this subsection and
23 section 6. The council shall establish an independent Request
24 for Information Review Committee to review and rank all
25 responses and to make a final recommendation to the council.
26 The Request for Information Review Committee shall consist of
27 the following members: <--
28 (i) Four members of the General Assembly, one each
29 to be appointed by the President Pro Tempore of the
30 Senate, the Minority Leader of the Senate, the Speaker of
20030S0387B1076 - 22 -
1 the House of Representatives and the Minority Leader of
2 the House of Representatives.
3 (ii) The following members appointed by the
4 Governor:
5 (A) One representative of the Hospital and
6 Healthsystem Association of Pennsylvania.
7 (B) One representative of the Pennsylvania
8 Medical Society.
9 (C) One representative of insurance.
10 (D) One representative of labor.
11 (E) One representative of business.
12 (F) Two representatives of the general public.
13 THE FOLLOWING MEMBERS APPOINTED BY THE GOVERNOR: <--
14 (I) ONE REPRESENTATIVE OF THE HOSPITAL AND
15 HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA.
16 (II) ONE REPRESENTATIVE OF THE PENNSYLVANIA MEDICAL
17 SOCIETY.
18 (III) ONE REPRESENTATIVE OF INSURANCE.
19 (IV) ONE REPRESENTATIVE OF LABOR.
20 (V) ONE REPRESENTATIVE OF BUSINESS.
21 (VI) TWO REPRESENTATIVES OF THE GENERAL PUBLIC.
22 (15) The council shall execute a request for quotations <--
23 with a PROPOSALS WITH third-party vendor VENDORS for the <--
24 purpose of demonstrating a methodology for the collection,
25 analysis and reporting of hospital-specific complication
26 rates. The results of this demonstration shall be shared with <--
27 the General Assembly. The council may recommend that this
28 PROVIDED TO THE CHAIRMAN AND MINORITY CHAIRMAN OF THE PUBLIC <--
29 HEALTH AND WELFARE COMMITTEE OF THE SENATE AND THE CHAIRMAN
30 AND MINORITY CHAIRMAN OF THE HEALTH AND HUMAN SERVICES
20030S0387B1076 - 23 -
1 COMMITTEE OF THE HOUSE OF REPRESENTATIVES. THIS methodology
2 be utilized for its MAY BE UTILIZED BY THE COUNCIL FOR public <--
3 reporting on comparative hospital complication rates.
4 Section 6. Data submission and collection.
5 (a) (1) Submission of data.--The council is hereby
6 authorized to collect and data sources are hereby required to
7 submit, upon request of the council, all data required in
8 this section, according to uniform submission formats, coding
9 systems and other technical specifications necessary to
10 render the incoming data substantially valid, consistent,
11 compatible and manageable using electronic data processing
12 according to data submission schedules, such schedules to
13 avoid, to the extent possible, submission of identical data
14 from more than one data source, established and promulgated
15 by the council in regulations pursuant to its authority under
16 section 5(b). If payor data is requested by the council, it
17 shall, to the extent possible, be obtained from primary payor
18 sources.
19 (2) Except as provided in this section, the council may
20 adopt any nationally recognized methodology to adjust data
21 submitted under subsection (c) for severity of illness. Every
22 three years after the effective date of this paragraph, the
23 council shall solicit bids from third-party vendors to adjust
24 the data. The solicitation shall be in accordance with 62
25 Pa.C.S. (relating to procurement). Except as provided in
26 subparagraph (i), in carrying out its responsibilities, the
27 council shall not require health care facilities to report
28 data elements which are not included in the manual developed
29 by the national uniform billing committee. The following
30 apply:
20030S0387B1076 - 24 -
1 (i) Within 60 days of the effective date of this
2 paragraph, the council shall publish in the Pennsylvania
3 Bulletin a list of diseases, procedures and medical
4 conditions, not to exceed 35, for which data under
5 subsections (c)(21) and (d) shall be required. The chosen
6 list shall not represent more than 50% of total hospital
7 discharges, based upon the previous year's hospital
8 discharge data. Subsequent to the publication of the
9 list, any data submission requirements under subsections
10 (c)(21) and (d) previously in effect shall be null and
11 void for diseases, procedures and medical conditions not
12 found on the list. All other data elements pursuant to
13 subsection (c) shall continue to be required from data
14 sources. The council shall review the list and may add no
15 more than a net of three diseases, procedures or medical
16 conditions per year over a five-year period starting on
17 the effective date of this subparagraph. The adjusted
18 list of diseases, procedures and medical conditions shall
19 at no time be more than 50% of total hospital discharges.
20 (ii) If the current data vendor is unable to
21 achieve, on a per-chart basis, savings of at least 40% in
22 the cost of hospital compliance with the data abstracting
23 and submission requirements of this act by June 30, 2004,
24 as compared to June 30, 2003, then the council shall
25 disqualify the current vendor and reopen the bidding
26 process. The independent auditor shall determine the
27 extent and validity of the savings. In determining any
28 demonstrated cost savings, surveys of all hospitals in
29 this Commonwealth shall be conducted and consideration
30 shall be given at a minimum to:
20030S0387B1076 - 25 -
1 (A) new costs, in terms of making the
2 methodology operational, associated with laboratory,
3 pharmacy and other information systems a hospital is
4 required to purchase in order to reduce hospital
5 compliance costs, including the cost of electronic
6 transfer of required data; and
7 (B) the audited direct personnel and related
8 costs of data abstracting and submission required.
9 (iii) Review by the independent auditor shall
10 commence by March 1, 2004, and shall conclude with a
11 report of findings by July 31, 2004. The report shall be
12 delivered to the council, the Governor, the Health and
13 Human Services Committee of the House of Representatives
14 and the Public Health and Welfare Committee of the
15 Senate.
16 (a.1) Abstraction and technology work group.--
17 (1) The council shall establish a data abstraction and
18 technology work group to produce recommendations for
19 improving and refining the data required by the council and
20 reducing, through innovative direct data collection
21 techniques, the cost of collecting required data. The work
22 group shall consist of the following members appointed by the
23 council:
24 (i) one member representing the Office of Health
25 Care Reform;
26 (ii) one member representing the business community;
27 (iii) one member representing labor;
28 (iv) one member representing consumers;
29 (v) two members representing physicians;
30 (vi) two members representing nurses;
20030S0387B1076 - 26 -
1 (vii) two members representing hospitals;
2 (viii) one member representing patient advocacy <--
3 groups;
4 (ix) (VIII) one member representing health <--
5 underwriters; and
6 (x) (IX) one member representing commercial <--
7 insurance carriers.
8 (2) The work group, with approval of the council, may
9 hire an independent evaluator AUDITOR to determine the value <--
10 of various data sets. The work group shall have no more than
11 one year to study current data requirements and methods of
12 collecting and transferring data and to make recommendations
13 for changes to produce a 50% overall reduction in the cost of
14 collecting and reporting required data to the council while
15 maintaining the scientific credibility of the council's
16 analysis and reporting. The work group recommendations shall
17 be presented to the council for a vote.
18 (c) Data elements.--For each covered service performed in
19 Pennsylvania, the council shall be required to collect the
20 following data elements:
21 (1) uniform patient identifier, continuous across
22 multiple episodes and providers;
23 (2) patient date of birth;
24 (3) patient sex;
25 (3.1) patient race, consistent with the method of
26 collection of race/ethnicity data by the United States Bureau
27 of the Census and the United States Standard Certificates of
28 Live Birth and Death;
29 (4) patient ZIP Code number;
30 (5) date of admission;
20030S0387B1076 - 27 -
1 (6) date of discharge;
2 (7) principal and [up to five] secondary diagnoses by <--
3 standard code, including external cause [code] OF INJURY, <--
4 COMPLICATION, INFECTION AND CHILDBIRTH;
5 (8) principal procedure by council-specified standard
6 code and date;
7 (9) up to three secondary procedures by council-
8 specified standard codes and dates;
9 (10) uniform health care facility identifier, continuous
10 across episodes, patients and providers;
11 (11) uniform identifier of admitting physician, by
12 unique physician identification number established by the
13 council, continuous across episodes, patients and providers;
14 (12) uniform identifier of consulting physicians, by
15 unique physician identification number established by the
16 council, continuous across episodes, patients and providers;
17 (13) total charges of health care facility, segregated
18 into major categories, including, but not limited to, room
19 and board, radiology, laboratory, operating room, drugs,
20 medical supplies and other goods and services according to
21 guidelines specified by the council;
22 (14) actual payments to health care facility,
23 segregated, if available, according to the categories
24 specified in paragraph (13);
25 (15) charges of each physician or professional rendering
26 service relating to an incident of hospitalization or
27 treatment in an ambulatory service facility;
28 (16) actual payments to each physician or professional
29 rendering service pursuant to paragraph (15);
30 (17) uniform identifier of primary payor;
20030S0387B1076 - 28 -
1 (18) ZIP Code number of facility where health care
2 service is rendered;
3 (19) uniform identifier for payor group contract number;
4 (20) patient discharge status; [and]
5 (21) provider service effectiveness and provider quality
6 pursuant to section 5(d)(4) and subsection (d).[.]; <--
7 (22) all external cause of injury codes, commonly called
8 E-codes;
9 (23) codes indicating complications;
10 (24) codes indicating infections; and
11 (25) baby and mother birth codes.
12 (d) Provider quality and provider service effectiveness data
13 elements.--In carrying out its duty to collect data on provider
14 quality and provider service effectiveness under section 5(d)(4)
15 and subsection (c)(21), the council shall define a methodology
16 to measure provider service effectiveness which may include
17 additional data elements to be specified by the council
18 sufficient to carry out its responsibilities under section
19 5(d)(4). The council may adopt a nationally recognized
20 methodology of quantifying and collecting data on provider
21 quality and provider service effectiveness until such time as
22 the council has the capability of developing its own methodology
23 and standard data elements. The council shall include in the
24 Pennsylvania Uniform Claims and Billing Form a field consisting
25 of the data elements required pursuant to subsection (c)(21) to
26 provide information on each provision of covered services
27 sufficient to permit analysis of provider quality and provider
28 service effectiveness within 180 days of commencement of its
29 operations pursuant to section 4. In carrying out its
30 responsibilities, the council shall not require health care
20030S0387B1076 - 29 -
1 insurers to report on data elements that are not reported to
2 nationally recognized accrediting organizations, to the
3 Department of Health or to the Insurance Department in quarterly
4 or annual reports. The council shall not require reporting by
5 health care insurers in different formats than are required for
6 reporting to nationally recognized accrediting organizations or
7 on quarterly or annual reports submitted to the Department of
8 Health or to the Insurance Department. The council may adopt the
9 quality findings as reported to nationally recognized
10 accrediting organizations.
11 (e) Reserve field utilization and addition or deletion of
12 data elements.--The council shall include in the Pennsylvania
13 Uniform Claims and Billing Form a reserve field. The council may
14 utilize the reserve field by adding other data elements beyond
15 those required to carry out its responsibilities under section
16 5(d)(3) and (4) and subsections (c) and (d), or the council may
17 delete data elements from the Pennsylvania Uniform Claims and
18 Billing Form only by a majority vote of the council and only
19 pursuant to the following procedure:
20 (1) The council shall obtain a cost-benefit analysis of
21 the proposed addition or deletion which shall include the
22 cost to data sources of any proposed additions.
23 (2) The council shall publish notice of the proposed
24 addition or deletion, along with a copy or summary of the
25 cost-benefit analysis, in the Pennsylvania Bulletin, and such
26 notice shall include provision for a 60-day comment period.
27 (3) The council may hold additional hearings or request
28 such other reports as it deems necessary and shall consider
29 the comments received during the 60-day comment period and
30 any additional information gained through such hearings or
20030S0387B1076 - 30 -
1 other reports in making a final determination on the proposed
2 addition or deletion.
3 (f) Other data required to be submitted.--Providers are
4 hereby required to submit and the council is hereby authorized
5 to collect, in accordance with submission dates and schedules
6 established by the council, the following additional data,
7 provided such data is not available to the council from public
8 records:
9 (1) Audited annual financial reports of all hospitals
10 and ambulatory service facilities providing covered services
11 as defined in section 3.
12 (2) The Medicare cost report (OMB Form 2552 or
13 equivalent Federal form), or the AG-12 form for Medical
14 Assistance or successor forms, whether completed or partially
15 completed, and including the settled Medicare cost report and
16 the certified AG-12 form.
17 (3) Additional data, including, but not limited to, data
18 which can be used to provide at least the following
19 information:
20 (i) the incidence of medical and surgical procedures
21 in the population for individual providers;
22 (ii) physicians who provide covered services and
23 accept medical assistance patients;
24 (iii) physicians who provide covered services and
25 accept Medicare assignment as full payment;
26 (v) mortality rates for specified diagnoses and
27 treatments, grouped by severity, for individual
28 providers;
29 (vi) rates of infection for specified diagnoses and
30 treatments, grouped by severity, for individual
20030S0387B1076 - 31 -
1 providers;
2 (vii) morbidity rates for specified diagnoses and
3 treatments, grouped by severity, for individual
4 providers;
5 (viii) readmission rates for specified diagnoses and
6 treatments, grouped by severity, for individual
7 providers; and
8 (ix) rate of incidence of postdischarge professional
9 care for selected diagnoses and procedures, grouped by
10 severity, for individual providers.
11 (4) Any other data the council requires to carry out its
12 responsibilities pursuant to section 5(d).
13 (f.1) Review and correction of data.--The council shall
14 provide a reasonable period for data sources to review and
15 correct the data submitted under section 6 which the council
16 intends to prepare and issue in reports to the General Assembly,
17 to the general public or in special studies and reports under
18 section 11. When corrections are provided, the council shall
19 correct the appropriate data in its data files and subsequent
20 reports.
21 (g) Allowance for clarification or dissents.--The council
22 shall maintain a file of written statements submitted by data
23 sources who wish to provide an explanation of data that they
24 feel might be misleading or misinterpreted. The council shall
25 provide access to such file to any person and shall, where
26 practical, in its reports and data files indicate the
27 availability of such statements. When the council agrees with
28 such statements, it shall correct the appropriate data and
29 comments in its data files and subsequent reports.
30 (g.1) Allowance for correction.--The council shall verify
20030S0387B1076 - 32 -
1 the PATIENT SAFETY INDICATOR data submitted by hospitals <--
2 pursuant to subsection (c)(22) through (25) (C)(7) within 60 <--
3 days of receipt. The council may allow hospitals to make changes
4 to the data submitted during the verification period. After the
5 verification period, but within 45 days of receipt of the <--
6 adjusted hospital data, the council shall risk adjust the
7 information and provide reports to the patient safety committee
8 of the relevant hospital.
9 (h) Availability of data.--Nothing in this act shall
10 prohibit a purchaser from obtaining from its health care
11 insurer, nor relieve said health care insurer from the
12 obligation of providing said purchaser, on terms consistent with
13 past practices, data previously provided or additional data not
14 currently provided to said purchaser by said health care insurer
15 pursuant to any existing or future arrangement, agreement or
16 understanding.
17 Section 7. Data dissemination and publication.
18 [(a) Public reports.--Subject to the restrictions on access
19 to council data set forth in section 10 and utilizing the data
20 collected under section 6 as well as other data, records and
21 matters of record available to it, the council shall prepare and
22 issue reports to the General Assembly and to the general public,
23 according to the following provisions:
24 (1) The council shall, for every provider within the
25 Commonwealth and within appropriate regions and subregions
26 within the Commonwealth and for those inpatient and
27 outpatient services which, when ranked by order of frequency,
28 account for at least 65% of all covered services and which,
29 when ranked by order of total payments, account for at least
30 65% of total payments, prepare and issue reports that at
20030S0387B1076 - 33 -
1 least provide information on the following:
2 (i) Comparisons among all providers of payments
3 received, charges, population-based admission or
4 incidence rates, and provider service effectiveness, such
5 comparisons to be grouped according to diagnosis and
6 severity, and to identify each provider by name and type
7 or specialty.
8 (ii) Comparisons among all providers, except
9 physicians, of inpatient and outpatient charges and
10 payments for room and board, ancillary services, drugs,
11 equipment and supplies and total services, such
12 comparisons to be grouped according to provider quality
13 and provider service effectiveness and according to
14 diagnosis and severity, and to identify each health care
15 facility by name and type.
16 (iii) Until and unless a methodology to measure
17 provider quality and provider service effectiveness
18 pursuant to sections 5(d)(4) and 6(c) and (d) is
19 available to the council, comparisons among all
20 providers, grouped according to diagnosis, procedure and
21 severity, which identify facilities by name and type and
22 physicians by name and specialty, of charges and payments
23 received, readmission rates, mortality rates, morbidity
24 rates and infection rates. Following adoption of the
25 methodology specified in sections 5(d)(4) and 6(c) and
26 (d), the council may, at its discretion, discontinue
27 publication of this component of the report.
28 (iv) The incidence rate of selected medical or
29 surgical procedures, the provider service effectiveness
30 and the payments received for those providers, identified
20030S0387B1076 - 34 -
1 by the name and type or specialty, for which these
2 elements vary significantly from the norms for all
3 providers.
4 (2) In preparing its reports under paragraph (1), the
5 council shall ensure that factors which have the effect of
6 either reducing provider revenue or increasing provider
7 costs, and other factors beyond a provider's control which
8 reduce provider competitiveness in the market place, are
9 explained in the reports. It shall also ensure that any
10 clarifications and dissents submitted by individual providers
11 under section 6(g) are noted in any reports that include
12 release of data on that individual provider.
13 (3) The council shall, for all providers within the
14 Commonwealth and within appropriate regions and subregions
15 within the Commonwealth, prepare and issue quarterly reports
16 that at least provide information on the number of
17 physicians, by specialty, on the staff of each hospital or
18 ambulatory service facility and those physicians on the staff
19 that accept Medicare assignment as full payment and that
20 accept Medical Assistance patients.
21 (4) The council shall publish all reports required in
22 this section in the Pennsylvania Bulletin and shall publish,
23 in at least one newspaper of general circulation in each
24 subregion within the Commonwealth, reports on the providers
25 in that subregion and subregions adjacent to it. In addition,
26 the council shall advertise annually the availability of
27 these reports and the charge for duplication in the
28 Pennsylvania Bulletin and in at least one newspaper of
29 general circulation in each subregion within the Commonwealth
30 at least once in each calendar quarter.]
20030S0387B1076 - 35 -
1 (a) Public reports.--Subject to the restrictions on access
2 to council data set forth in section 10 and utilizing the data
3 collected under section 6 as well as other data, records and
4 matters of record available to it, the council shall prepare and
5 issue reports to the General Assembly and to the general public,
6 according to the following provisions:
7 (1) The council shall, for every provider of both
8 inpatient and outpatient services within this Commonwealth
9 and within appropriate regions and subregions, prepare and
10 issue reports on provider quality and service effectiveness
11 on diseases or procedures that, when ranked by volume, cost,
12 payment and high variation in outcome, represent the best
13 opportunity to improve overall provider quality, improve
14 patient safety and provide opportunities for cost reduction.
15 These reports shall provide comparative information on the
16 following:
17 (i) Differences in mortality rates; differences in
18 length of stay; differences in complication rates;
19 differences in readmission rates; differences in
20 infection rates; and other comparative outcome measures
21 the council may develop that will allow purchasers,
22 providers and consumers to make purchasing and quality
23 improvement decisions based upon quality patient care and
24 to restrain costs.
25 (ii) The incidence rate of selected medical or
26 surgical procedures, the quality and service
27 effectiveness and the payments received for those
28 providers, identified by the name and type or specialty,
29 for which these elements vary significantly from the
30 norms for all providers.
20030S0387B1076 - 36 -
1 (2) In preparing its reports under paragraph (1), the
2 council shall ensure that factors which have the effect of
3 either reducing provider revenue or increasing provider costs
4 and other factors beyond a provider's control which reduce
5 provider competitiveness in the marketplace are explained in
6 the reports. The council shall also ensure that any
7 clarifications and dissents submitted by individual providers
8 under section 6(g) are noted in any reports that include
9 release of data on that individual provider.
10 (b) Raw data reports and computer access to council data.--
11 The council shall provide special reports derived from raw data
12 and a means for computer-to-computer access to its raw data to
13 any purchaser, pursuant to section 10(f). The council shall
14 provide such reports and computer-to-computer access, at its
15 discretion, to other parties, pursuant to section 10(g). The
16 council shall provide these special reports and computer-to-
17 computer access in as timely a fashion as the council's
18 responsibilities to publish the public reports required in this
19 section will allow. Any such provision of special reports or
20 computer-to-computer access by the council shall be made only
21 subject to the restrictions on access to raw data set forth in
22 section 10(b) and only after payment for costs of preparation or
23 duplication pursuant to section 10(f) or (g).
24 Section 3. Section 8 of the act is reenacted to read:
25 Section 8. Health care for the medically indigent.
26 (a) Declaration of policy.--The General Assembly finds that
27 every person in this Commonwealth should receive timely and
28 appropriate health care services from any provider operating in
29 this Commonwealth; that, as a continuing condition of licensure,
30 each provider should offer and provide medically necessary,
20030S0387B1076 - 37 -
1 lifesaving and emergency health care services to every person in
2 this Commonwealth, regardless of financial status or ability to
3 pay; and that health care facilities may transfer patients only
4 in instances where the facility lacks the staff or facilities to
5 properly render definitive treatment.
6 (b) Studies on indigent care.--To reduce the undue burden on
7 the several providers that disproportionately treat medically
8 indigent people on an uncompensated basis, to contain the long-
9 term costs generated by untreated or delayed treatment of
10 illness and disease and to determine the most appropriate means
11 of treating and financing the treatment of medically indigent
12 persons, the council, at the request of the Governor or the
13 General Assembly, may undertake studies and utilize its current
14 data base to:
15 (1) Study and analyze the medically indigent population,
16 the magnitude of uncompensated care for the medically
17 indigent, the degree of access to and the result of any lack
18 of access by the medically indigent to appropriate care, the
19 types of providers and the settings in which they provide
20 indigent care and the cost of the provision of that care
21 pursuant to subsection (c).
22 (2) Determine, from studies undertaken under paragraph
23 (1), a definition of the medically indigent population and
24 the most appropriate method for the delivery of timely and
25 appropriate health care services to the medically indigent.
26 (c) Studies.--The council shall conduct studies pursuant to
27 subsection (b)(1) and thereafter report to the Governor and the
28 General Assembly the results of the studies and its
29 recommendations. The council may contract with an independent
30 vendor to conduct the study in accordance with the provisions
20030S0387B1076 - 38 -
1 for selecting vendors in section 16. The study shall include,
2 but not be limited to, the following:
3 (1) the number and characteristics of the medically
4 indigent population, including such factors as income,
5 employment status, health status, patterns of health care
6 utilization, type of health care needed and utilized,
7 eligibility for health care insurance, distribution of this
8 population on a geographic basis and by age, sex and racial
9 or linguistic characteristics, and the changes in these
10 characteristics, including the following:
11 (i) the needs and problems of indigent persons in
12 urban areas;
13 (ii) the needs and problems of indigent persons in
14 rural areas;
15 (iii) the needs and problems of indigent persons who
16 are members of racial or linguistic minorities;
17 (iv) the needs and problems of indigent persons in
18 areas of high unemployment; and
19 (v) the needs and problems of the underinsured;
20 (2) the degree of and any change in access of this
21 population to sources of health care, including hospitals,
22 physicians and other providers;
23 (3) the distribution and means of financing indigent
24 care between and among providers, insurers, government,
25 purchasers and consumers, and the effect of that distribution
26 on each;
27 (4) the major types of care rendered to the indigent,
28 the setting in which each type of care is rendered and the
29 need for additional care of each type by the indigent;
30 (5) the likely impact of changes in the health delivery
20030S0387B1076 - 39 -
1 system, including managed care entities, and the effects of
2 cost containment in the Commonwealth on the access to,
3 availability of and financing of needed care for the
4 indigent, including the impact on providers which provide a
5 disproportionate amount of care to the indigent;
6 (6) the distribution of delivered care and actual cost
7 to render such care by provider, region and subregion;
8 (7) the provision of care to the indigent through
9 improvements in the primary health care system, including the
10 management of needed hospital care by primary care providers;
11 (8) innovative means to finance and deliver care to the
12 medically indigent; and
13 (9) reduction in the dependence of indigent persons on
14 hospital services through improvements in preventive health
15 measures.
16 Section 4. Sections 9 and 10 of the act are reenacted and
17 amended to read:
18 Section 9. Mandated health benefits.
19 In relation to current law or proposed legislation, the
20 council shall, upon the request of the appropriate committee
21 chairman in the Senate and in the House of Representatives or
22 upon the request of the Secretary of Health, provide information
23 on the proposed mandated health benefit pursuant to the
24 following:
25 (1) The General Assembly hereby declares that proposals
26 for mandated health benefits or mandated health insurance
27 coverage should be accompanied by adequate, independently
28 certified documentation defining the social and financial
29 impact and medical efficacy of the proposal. To that end the
30 council, upon receipt of such requests, is hereby authorized
20030S0387B1076 - 40 -
1 to conduct a preliminary review of the material submitted by
2 both proponents and opponents concerning the proposed
3 mandated benefit. If, after this preliminary review, the
4 council is satisfied that both proponents and opponents have
5 submitted sufficient documentation necessary for a review
6 pursuant to paragraphs (3) and (4), the council is directed
7 to contract with individuals, pursuant to the selection
8 procedures for vendors set forth in section 16, who will
9 constitute a Mandated Benefits Review Panel to review
10 mandated benefits proposals and provide independently
11 certified documentation, as provided for in this section.
12 (2) The panel shall consist of [four] senior <--
13 researchers, each of whom shall be a recognized expert:
14 (i) one in health research;
15 (ii) one in biostatistics;
16 (iii) one in economic research; [and]
17 (iv) one, a physician, in the appropriate specialty
18 with current knowledge of the subject being proposed as a
19 mandated benefit; and
20 (v) one with experience in insurance or actuarial
21 research.
22 (3) The Mandated Benefits Review Panel shall have the
23 following duties and responsibilities:
24 (i) To review documentation submitted by persons
25 proposing or opposing mandated benefits within 90 days of
26 submission of said documentation to the panel.
27 (ii) To report to the council, pursuant to its
28 review in subparagraph (i), the following:
29 (A) Whether or not the documentation is complete
30 as defined in paragraph (4).
20030S0387B1076 - 41 -
1 (B) Whether or not the research cited in the
2 documentation meets professional standards.
3 (C) Whether or not all relevant research
4 respecting the proposed mandated benefit has been
5 cited in the documentation.
6 (D) Whether or not the conclusions and
7 interpretations in the documentation are consistent
8 with the data submitted.
9 (4) To provide the Mandated Benefits Review Panel with
10 sufficient information to carry out its duties and
11 responsibilities pursuant to paragraph (3), persons proposing
12 or opposing legislation mandating benefits coverage should
13 submit documentation to the council, pursuant to the
14 procedure established in paragraph (5), which demonstrates
15 the following:
16 (i) The extent to which the proposed benefit and the
17 services it would provide are needed by, available to and
18 utilized by the population of the Commonwealth.
19 (ii) The extent to which insurance coverage for the
20 proposed benefit already exists, or if no such coverage
21 exists, the extent to which this lack of coverage results
22 in inadequate health care or financial hardship for the
23 population of the Commonwealth.
24 (iii) The demand for the proposed benefit from the
25 public and the source and extent of opposition to
26 mandating the benefit.
27 (iv) All relevant findings bearing on the social
28 impact of the lack of the proposed benefit.
29 (v) Where the proposed benefit would mandate
30 coverage of a particular therapy, the results of at least
20030S0387B1076 - 42 -
1 one professionally accepted, controlled trial comparing
2 the medical consequences of the proposed therapy,
3 alternative therapies and no therapy.
4 (vi) Where the proposed benefit would mandate
5 coverage of an additional class of practitioners, the
6 results of at least one professionally accepted,
7 controlled trial comparing the medical results achieved
8 by the additional class of practitioners and those
9 practitioners already covered by benefits.
10 (vii) The results of any other relevant research.
11 (viii) Evidence of the financial impact of the
12 proposed legislation, including at least:
13 (A) The extent to which the proposed benefit
14 would increase or decrease cost for treatment or
15 service.
16 (B) The extent to which similar mandated
17 benefits in other states have affected charges, costs
18 and payments for services.
19 (C) The extent to which the proposed benefit
20 would increase the appropriate use of the treatment
21 or service.
22 (D) The impact of the proposed benefit on
23 administrative expenses of health care insurers.
24 (E) The impact of the proposed benefits on
25 benefits costs of purchasers.
26 (F) The impact of the proposed benefits on the
27 total cost of health care within the Commonwealth.
28 (5) The procedure for review of documentation is as
29 follows:
30 (i) Any person wishing to submit information on
20030S0387B1076 - 43 -
1 proposed legislation mandating insurance benefits for
2 review by the panel should submit the documentation
3 specified in paragraph (4) to the council.
4 (ii) The council shall, within 30 days of receipt of
5 the documentation:
6 (A) Publish in the Pennsylvania Bulletin notice
7 of receipt of the documentation, a description of the
8 proposed legislation, provision for a period of 60
9 days for public comment and the time and place at
10 which any person may examine the documentation.
11 (B) Submit copies of the documentation to the
12 Secretary of Health and the Insurance Commissioner,
13 who shall review and submit comments to the council
14 on the proposed legislation within 30 days.
15 (C) Submit copies of the documentation to the
16 panel, which shall review the documentation and issue
17 their findings, pursuant to paragraph (3), within 90
18 days.
19 (iii) Upon receipt of the comments of the Secretary
20 of Health and the Insurance Commissioner and of the
21 findings of the panel, pursuant to subparagraph (ii), but
22 no later than 120 days following the publication required
23 in subparagraph (ii), the council shall submit said
24 comments and findings, together with its recommendations
25 respecting the proposed legislation, to the Governor, the
26 President pro tempore of the Senate, the Speaker of the
27 House of Representatives, the Secretary of Health, the
28 Insurance Commissioner and the person who submitted the
29 information pursuant to subparagraph (i).
30 Section 10. Access to council data.
20030S0387B1076 - 44 -
1 (a) Public access.--The information and data received by the
2 council shall be utilized by the council for the benefit of the
3 public and public officials. Subject to the specific limitations
4 set forth in this section, the council shall make determinations
5 on requests for information in favor of access.
6 (a.1) Outreach programs.--The council shall develop and
7 implement outreach programs designed to make its information
8 understandable and usable to purchasers, providers, other
9 Commonwealth agencies and the general public. The programs shall
10 include efforts to educate through pamphlets, booklets, seminars
11 and other appropriate measures and to facilitate making more
12 informed health care choices.
13 (b) Limitations on access.--Unless specifically provided for
14 in this act, neither the council nor any contracting system
15 vendor shall release and no data source, person, member of the
16 public or other user of any data of the council shall gain
17 access to:
18 (1) Any raw data of the council that does not
19 simultaneously disclose payment, as well as provider quality
20 and provider service effectiveness pursuant to sections
21 5(d)(4) and 6(d) or 7(a)(1)(iii).
22 (2) Any raw data of the council which could reasonably
23 be expected to reveal the identity of an individual patient.
24 (3) Any raw data of the council which could reasonably
25 be expected to reveal the identity of any purchaser, as
26 defined in section 3, other than a purchaser requesting data
27 on its own group or an entity entitled to said purchaser's
28 data pursuant to subsection (f).
29 (4) Any raw data of the council relating to actual
30 payments to any identified provider made by any purchaser,
20030S0387B1076 - 45 -
1 except that this provision shall not apply to access by a
2 purchaser requesting data on the group for which it purchases
3 or otherwise provides covered services or to access to that
4 same data by an entity entitled to the purchaser's data
5 pursuant to subsection (f).
6 (5) Any raw data disclosing discounts or differentials
7 between payments accepted by providers for services and their
8 billed charges obtained by identified payors from identified
9 providers unless [comparable data on all other payors is also
10 released] the data is released in a Statewide, aggregate
11 format that does not identify any individual payor or class
12 of payors and the council [determines] assures that the
13 release of such information is not prejudicial or inequitable
14 to any individual payor or provider or group thereof. [In
15 making such determination the council shall consider that it
16 is primarily concerned with the analysis and dissemination of
17 payments to providers, not with discounts.]
18 (c) Unauthorized use of data.--Any person who knowingly
19 releases council data violating the patient confidentiality,
20 actual payments, discount data or raw data safeguards set forth
21 in this section to an unauthorized person commits a misdemeanor
22 of the first degree and shall, upon conviction, be sentenced to
23 pay a fine of $10,000 or to imprisonment for not more than five
24 years, or both. An unauthorized person who knowingly receives or
25 possesses such data commits a misdemeanor of the first degree.
26 (d) Unauthorized access to data.--Should any person
27 inadvertently or by council error gain access to data that
28 violates the safeguards set forth in this section, the data must
29 immediately be returned, without duplication, to the council
30 with proper notification.
20030S0387B1076 - 46 -
1 (e) Public access to records.--All public reports prepared
2 by the council shall be public records and shall be available to
3 the public for a reasonable fee, and copies shall be provided,
4 upon request of the chair, to the Public Health and Welfare
5 Committee of the Senate and the Health and Welfare Committee of
6 the House of Representatives.
7 (f) Access to raw council data by purchasers.--Pursuant to
8 sections 5(d)(5) and 7(b) and subject to the limitations on
9 access set forth in subsection (b), the council shall provide
10 access to its raw data to purchasers in accordance with the
11 following procedure:
12 (1) Special reports derived from raw data of the council
13 shall be provided by the council to any purchaser requesting
14 such reports.
15 (2) A means to enable computer-to-computer access by any
16 purchaser to raw data of the council as defined in section 3
17 shall be developed, adopted and implemented by the council,
18 and the council shall provide such access to its raw data to
19 any purchaser upon request.
20 (3) In the event that any employer obtains from the
21 council, pursuant to paragraph (1) or (2), data pertaining to
22 its employees and their dependents for whom said employer
23 purchases or otherwise provides covered services as defined
24 in section 3 and who are represented by a certified
25 collective bargaining representative, said collective
26 bargaining representative shall be entitled to that same
27 data, after payment of fees as specified in paragraph (4).
28 Likewise, should a certified collective bargaining
29 representative obtain from the council, pursuant to paragraph
30 (1) or (2), data pertaining to its members and their
20030S0387B1076 - 47 -
1 dependents who are employed by and for whom covered services
2 are purchased or otherwise provided by any employer, said
3 employer shall be entitled to that same data, after payment
4 of fees as specified in paragraph (4).
5 (4) In providing for access to its raw data, the council
6 shall charge the purchasers which originally obtained such
7 access a fee sufficient to cover its costs to prepare and
8 provide special reports requested pursuant to paragraph (1)
9 or to provide computer-to-computer access to its raw data
10 requested pursuant to paragraph (2). Should a second or
11 subsequent party or parties request this same information
12 pursuant to paragraph (3), the council shall charge said
13 party a reasonable fee.
14 (g) Access to raw council data by other parties.--Subject to
15 the limitations on access to raw council data set forth in
16 subsection (b), the council may, at its discretion, provide
17 special reports derived from its raw data or computer-to-
18 computer access to parties other than purchasers. The council
19 shall publish regulations that set forth the criteria and the
20 procedure it shall use in making determinations on such access,
21 pursuant to the powers vested in the council in section 4. In
22 providing such access, the council shall charge the party
23 requesting the access a reasonable fee.
24 Section 5. Section 11 of the act is reenacted to read:
25 Section 11. Special studies and reports.
26 (a) Special studies.--Any Commonwealth agency may publish or
27 contract for publication of special studies. Any special study
28 so published shall become a public document.
29 (b) Special reports.--
30 (1) Any Commonwealth agency may study and issue a report
20030S0387B1076 - 48 -
1 on the special medical needs, demographic characteristics,
2 access or lack thereof to health care services and need for
3 financing of health care services of:
4 (i) Senior citizens, particularly low-income senior
5 citizens, senior citizens who are members of minority
6 groups and senior citizens residing in low-income urban
7 or rural areas.
8 (ii) Low-income urban or rural areas.
9 (iii) Minority communities.
10 (iv) Women.
11 (v) Children.
12 (vi) Unemployed workers.
13 (vii) Veterans.
14 The reports shall include information on the current
15 availability of services to these targeted parts of the
16 population, and whether access to such services has increased
17 or decreased over the past ten years, and specific
18 recommendations for the improvement of their primary care and
19 health delivery systems, including disease prevention and
20 comprehensive health care services. The department may also
21 study and report on the effects of using prepaid, capitated
22 or HMO health delivery systems as ways to promote the
23 delivery of primary health care services to the underserved
24 segments of the population enumerated above.
25 (2) The department may study and report on the short-
26 term and long-term fiscal and programmatic impact on the
27 health care consumer of changes in ownership of hospitals
28 from nonprofit to profit, whether through purchase, merger or
29 the like. The department may also study and report on factors
30 which have the effect of either reducing provider revenue or
20030S0387B1076 - 49 -
1 increasing provider cost, and other factors beyond a
2 provider's control which reduce provider competitiveness in
3 the marketplace, are explained in the reports.
4 Section 6. Section 12 of the act is reenacted and amended to
5 read:
6 Section 12. Enforcement; penalty.
7 (a) Compliance enforcement.--The council shall have standing
8 to bring an action in law or in equity through private counsel
9 in any court of common pleas to enforce compliance with any
10 provision of this act, except section 11, or any requirement or
11 appropriate request of the council made pursuant to this act. In
12 addition, the Attorney General is authorized and shall bring any
13 such enforcement action in aid of the council in any court of
14 common pleas at the request of the council in the name of the
15 Commonwealth.
16 (b) Penalty.--
17 (1) Any person who fails to supply data pursuant to
18 section 6 [commits a misdemeanor of the third degree and
19 shall, upon conviction, be sentenced to pay a fine not to
20 exceed $1,000. Each day on which the required data is not
21 submitted constitutes a separate offense under this
22 paragraph.] shall MAY be assessed a civil penalty not to <--
23 exceed $1,000 for each day the data is not submitted.
24 (2) [Any person who, after being sentenced under
25 paragraph (1), fails to supply data pursuant to section 6
26 commits a misdemeanor of the third degree and shall, upon
27 conviction, be sentenced to pay a fine of $10,000 or to
28 imprisonment for not more than five years, or both.] Any
29 person who knowingly submits inaccurate data under section 6
30 commits a misdemeanor of the third degree and shall, upon
20030S0387B1076 - 50 -
1 conviction, be sentenced to pay a fine of $1,000 or to
2 imprisonment for not more than one year, or both.
3 Section 7. Sections 13, 14, 15, 16, 17.1 and 18 of the act
4 are reenacted to read:
5 Section 13. Research and demonstration projects.
6 The council shall actively encourage research and
7 demonstrations to design and test improved methods of assessing
8 provider quality, provider service effectiveness and efficiency.
9 To that end, provided that no data submission requirements in a
10 mandated demonstration may exceed the current reserve field on
11 the Pennsylvania Uniform Claims and Billing Form, the council
12 may:
13 (1) Authorize contractors engaged in health services
14 research selected by the council, pursuant to the provisions
15 of section 16, to have access to the council's raw data
16 files, providing such entities assume any contractual
17 obligations imposed by the council to assure patient identity
18 confidentiality.
19 (2) Place data sources participating in research and
20 demonstrations on different data submission requirements from
21 other data sources in this Commonwealth.
22 (3) Require data source participation in research and
23 demonstration projects when this is the only testing method
24 the council determines is promising.
25 Section 14. Grievances and grievance procedures.
26 (a) Procedures and requirements.--Pursuant to its powers to
27 publish regulations under section 5(b) and with the requirements
28 of this section, the council is hereby authorized and directed
29 to establish procedures and requirements for the filing, hearing
30 and adjudication of grievances against the council of any data
20030S0387B1076 - 51 -
1 source. Such procedures and requirements shall be published in
2 the Pennsylvania Bulletin pursuant to law.
3 (b) Claims; hearings.--Grievance claims of any data source
4 shall be submitted to the council or to a third party designated
5 by the council, and the council or the designated third party
6 shall convene a hearing, if requested, and adjudicate the
7 grievance.
8 Section 15. Antitrust provisions.
9 Persons or entities required to submit data or information
10 under this act or receiving data or information from the council
11 in accordance with this act are declared to be acting pursuant
12 to State requirements embodied in this act and shall be exempt
13 from antitrust claims or actions grounded upon submission or
14 receipt of such data or information.
15 Section 16. Contracts with vendors.
16 Any contract with any vendor other than a sole source vendor
17 for purchase of services or for purchase or lease of supplies
18 and equipment related to the council's powers and duties shall
19 be let only after a public bidding process and only in
20 accordance with the following provisions, and no contract shall
21 be let by the council that does not conform to these provisions:
22 (1) The council shall prepare specifications fully
23 describing the services to be rendered or equipment or
24 supplies to be provided by a vendor and shall make these
25 specifications available for inspection by any person at the
26 council's offices during normal working hours and at such
27 other places and such other times as the council deems
28 advisable.
29 (2) The council shall publish notice of invitations to
30 bid in the Pennsylvania Bulletin. The council shall also
20030S0387B1076 - 52 -
1 publish such notice in at least four newspapers in general
2 circulation in the Commonwealth on at least three occasions
3 at intervals of not less than three days. Said notice shall
4 include at least the following:
5 (i) The deadline for submission of bids by
6 prospective vendors, which shall be no sooner than 30
7 days following the latest publication of the notice as
8 prescribed in this paragraph.
9 (ii) The locations, dates and times during which
10 prospective vendors can examine the specifications
11 required in paragraph (1).
12 (iii) The date, time and place of the meeting or
13 meetings of the council at which bids will be opened and
14 accepted.
15 (iv) A statement to the effect that any person is
16 eligible to bid.
17 (3) Bids shall be accepted as follows:
18 (i) No council member who is affiliated in any way
19 with any bidder shall vote on the awarding of any
20 contract for which said bidder has submitted a bid, and
21 any council member who has an affiliation with a bidder
22 shall state the nature of the affiliation prior to any
23 vote of the council.
24 (ii) Bids shall be opened and reviewed by the
25 appropriate council committee, which shall make
26 recommendations to the council on approval. Bids shall be
27 accepted and such acceptance shall be announced only at a
28 public meeting of the council as defined in section 4(e),
29 and no bids shall be accepted at an executive session of
30 the council.
20030S0387B1076 - 53 -
1 (iii) The council may require that a certified
2 check, in an amount determined by the council, accompany
3 every bid, and, when so required, no bid shall be
4 accepted unless so accompanied.
5 (4) In order to prevent any party from deliberately
6 underbidding contracts in order to gain or prevent access to
7 council data, the council may award any contract at its
8 discretion, regardless of the amount of the bid, pursuant to
9 the following:
10 (i) Any bid accepted must reasonably reflect the
11 actual cost of services provided.
12 (ii) Any vendor so selected by the council shall be
13 found by the council to be of such character and such
14 integrity as to assure, to the maximum extent possible,
15 adherence to all the provisions of this act in the
16 provision of contracted services.
17 (iii) The council may require the selected vendor to
18 furnish, within 20 days after the contract has been
19 awarded, a bond with suitable and reasonable requirements
20 guaranteeing the services to be performed with sufficient
21 surety in an amount determined by the council, and upon
22 failure to furnish such bond within the time specified,
23 the previous award shall be void.
24 (5) The council shall make efforts to assure that its
25 vendors have established affirmative action plans to assure
26 equal opportunity policies for hiring and promoting
27 employees.
28 Section 17.1. Reporting.
29 The council shall provide an annual report of its financial
30 expenditures to the Appropriations Committee of the Senate and
20030S0387B1076 - 54 -
1 the Appropriations Committee of the House of Representatives.
2 Section 18. Severability.
3 The provisions of this act are severable. If any provision of
4 this act or its application to any person or circumstance is
5 held invalid, the invalidity shall not affect other provisions
6 or applications of this act which can be given effect without
7 the invalid provision or application.
8 Section 8. Section 19 of the act is reenacted and amended to
9 read:
10 Section 19. Sunset.
11 This act shall expire June 30, [2003] 2008, unless reenacted
12 prior to [that date.] September 1, 2007. By March BY SEPTEMBER <--
13 1, 2007, a written report by the Legislative Budget and Finance
14 Committee evaluating the management, visibility, awareness and
15 performance of the council shall be provided to the Public
16 Health and Welfare Committee of the Senate and the Health and
17 Human Services Committee of the House of Representatives. The
18 report shall include a review of the council's procedures and
19 policies, the availability and quality of data for completing
20 reports to hospitals and outside vendor purchasers; the ability
21 of the council to become self-sufficient by selling data to
22 outside purchasers; whether there is a more cost-efficient way
23 of accomplishing the objectives of the council and the need for
24 reauthorization of the council.
25 Section 9. Section 20 of the act is reenacted to read:
26 Section 20. Effective date.
27 This act shall take effect immediately.
28 SECTION 9.1. IN ACCORDANCE WITH SECTION 10 OF THIS ACT, THE <--
29 FOLLOWING APPLY TO THE PERIOD FROM JUNE 30, 2003, TO THE DAY
30 PRIOR TO THE EFFECTIVE DATE OF THIS SECTION:
20030S0387B1076 - 55 -
1 (1) THERE IS NO LAPSE IN MEMBERSHIP ON THE HEALTH CARE
2 COST CONTAINMENT COUNCIL.
3 (2) ELEVEN MEMBERS CONSTITUTE A QUORUM.
4 (3) ANY ACTION TAKEN BY THE COUNCIL IS VALIDATED.
5 (4) THERE SHALL BE NO LAPSE IN THE EMPLOYMENT
6 RELATIONSHIP FOR EMPLOYEES OF THE COUNCIL. THIS PARAGRAPH
7 INCLUDES SALARY, SENIORITY, BENEFITS AND RETIREMENT
8 ELIGIBILITY OF THE EMPLOYEES.
9 SECTION 9.2. NEW POSITIONS ON THE COUNCIL CREATED UNDER THIS
10 ACT SHALL BE FILLED IN THE MANNER DESIGNATED UNDER SECTION 4(B)
11 OF THE ACT NO LATER THAN 60 DAYS AFTER THE EFFECTIVE DATE OF
12 THIS ACT. ORGANIZATIONS REQUIRED UNDER SECTION 4(B) OF THE ACT
13 TO SUBMIT LISTS OF RECOMMENDED PERSONS TO FILL NEW POSITIONS ON
14 THE COUNCIL SHALL DO SO NO LATER THAN 30 DAYS AFTER THE
15 EFFECTIVE DATE OF THIS ACT.
16 Section 10. This act shall apply retroactively to June 29,
17 2003.
18 Section 11. This act shall take effect immediately.
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