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                                                      PRINTER'S NO. 2195



No. 1660 Session of 2007

           THOMAS, JULY 3, 2007


                                     AN ACT

     1  Providing for a Statewide comprehensive health care system;
     2     establishing the Pennsylvania Health Care Plan and providing
     3     for eligibility, services, coverages, subrogation,
     4     participating providers, cost containment, reduction of
     5     errors, tort remedies, administrative remedies and
     6     procedures, attorney fees, quality assurance,
     7     nonparticipating providers, transitional support and
     8     training; and establishing the Pennsylvania Health Care
     9     Agency, the Employer Health Services Levy, the Individual
    10     Wellness Tax and the Pennsylvania Health Care Board and
    11     providing for their powers and duties.

    12                         TABLE OF CONTENTS
    13  Chapter 1.  Preliminary Provisions
    14  Section 101.  Short title.
    15  Section 102.  Definitions.
    16  Chapter 3.  Administration and Oversight of the Pennsylvania
    17                 Health Care Plan
    18  Subchapter A.  Pennsylvania Health Care Board
    19  Section 301.  Organization.
    20  Section 302.  Duties of board.

     1  Subchapter B.  Pennsylvania Health Care Agency
     2  Section 321.  Pennsylvania Health Care Agency.
     3  Section 322.  Executive director duties.
     4  Section 323.  Administrator for planning, research and
     5                 development.
     6  Section 324.  Administrator for consumer affairs and health
     7                 education.
     8  Section 325.  Administrator for quality assurance.
     9  Section 326.  Administrator for finance.
    10  Section 327.  Administrator for claims.
    11  Section 328.  Administrator for volunteer services.
    12  Section 329.  Administrator for provider coordination.
    13  Section 330.  Administrator for law.
    14  Section 331.  Administrator for transition services.
    15  Section 332. Administrator for beneficiary advocate.
    16  Subchapter C.  (Reserved).
    17  Subchapter D.  (Reserved).
    18  Subchapter E.  (Reserved).
    19  Subchapter F.  Immunity
    20  Section 371. Immunity.
    21  Chapter 5.  Pennsylvania Health Care Plan
    22  Section 501.  General provisions.
    23  Section 502.  Universal health care access eligibility.
    24  Section 503.  Covered services.
    25  Section 504.  Excess and collective bargaining agreement health
    26                 insurance coverage.
    27  Section 505.  Duplicate coverage.
    28  Section 506.  Subrogation.
    29  Section 507.  Eligible participating providers and availability
    30                 of services.
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     1  Section 508.  Rational cost containment.
     2  Chapter 7.  No-Fault Administrative Remedies
     3  Section 701.  Rationalization of remedies for errors and
     4                 complications.
     5  Section 702.  Voluntary waiver of tort remedies and choice
     6                 to retain tort remedies.
     7  Section 703.  No-fault administrative remedies for those not
     8                 opting out.
     9  Section 704.  Administrative claims procedures.
    10  Section 705.  Beneficiary right to counsel.
    11  Section 706.  Quality assurance follow-up to claims.
    12  Section 707.  Surviving tort claims against participating
    13                 providers.
    14  Section 708.  Claims against nonparticipating providers.
    15  Section 709.  Parallel no-fault compensation for beneficiaries
    16                 injured by nonparticipating providers.
    17  Chapter 9.  Pennsylvania Health Care Trust Fund
    18  Section 901.  Pennsylvania Health Care Trust Fund.
    19  Section 902.  Rolling budget process.
    20  Section 903.  Limitation on administrative expense.
    21  Section 904.  Funding sources.
    22  Chapter 11.  Transitional Support and Training for Displaced
    23                 Workers
    24  Section 1101. Transitional support and training for displaced
    25                 workers.
    26  Chapter 13.  Volunteer Emergency Responder Network
    27  Section 1301.  Preservation of volunteer emergency responder
    28                 network.
    29  Section 1302.  Eligibility certification.
    30  Section 1303.  Eligibility criteria.
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     1  Section 1304.  Amount of tax credit.
     2  Section 1305.  Reimbursement of Department of Revenue.
     3  Chapter 15.  Miscellaneous Provisions
     4  Section 1501.  Effective date.
     5     The General Assembly of the Commonwealth of Pennsylvania
     6  hereby enacts as follows:
     7                             CHAPTER 1
     8                       PRELIMINARY PROVISIONS
     9  Section 101.  Short title.
    10     This act shall be known and may be cited as the Family and
    11  Business Healthcare Security Act.
    12  Section 102.  Definitions.
    13     The following words and phrases when used in this act shall
    14  have the meanings given to them in this section unless the
    15  context clearly indicates otherwise:
    16     "Agency."  The Pennsylvania Health Care Agency established
    17  under this act.
    18     "Board."  The Pennsylvania Health Care Board established
    19  under this act.
    20     "Department."  The Department of Health of the Commonwealth.
    21     "Executive director."  The Executive Director of the
    22  Pennsylvania Health Care Board.
    23     "Fund."  The Pennsylvania Health Care Trust Fund established
    24  under this act.
    25     "Individual Wellness Tax" or "IWT."  The Individual Wellness
    26  Tax established under this act.
    27     "Plan."  The Pennsylvania Health Care Plan established under
    28  this act.
    29     "Tax."  The Employer Health Services Levy established under
    30  this act.
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     1                             CHAPTER 3
     3                   PENNSYLVANIA HEALTH CARE PLAN
     4                            SUBCHAPTER A
     5                   PENNSYLVANIA HEALTH CARE BOARD
     6  Section 301.  Organization.
     7     (a)  Composition.--The Pennsylvania Health Care Board shall
     8  be composed of 11 voting members and shall be chaired by the
     9  executive director.
    10     (b)  Appointments.--
    11         (1)  The executive director shall be appointed by the
    12     Governor. The members of the board shall be appointed by the
    13     Governor, the President pro tempore of the Senate, and the
    14     Speaker of the House of Representatives who collectively
    15     shall make appointments of members from individuals
    16     representative of each of the following constituencies:
    17             (i)  Hospitals.
    18             (ii)  Organized labor, private sector.
    19             (iii)  Consumers.
    20             (iv)  Business.
    21             (v)  Agriculture.
    22             (vi)  Physicians.
    23             (vii)  Public sector employees.
    24             (viii)  Nurses.
    25             (ix)  Pharmacists.
    26             (x)  Long-term care facilities.
    27             (xi)  Social workers.
    28         (2)  The Governor shall initially appoint the executive
    29     director, who shall serve as chair of the board, appointments
    30     of the members shall thereafter be made in a rotating fashion
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     1     beginning with the President pro tempore of the Senate, then
     2     the Speaker of the House of Representatives and then the
     3     Governor, with each in turn making an appointment from a
     4     constituency category not previously filled.
     5     (c)  Terms of members.--Each member appointed or reappointed
     6  under this section shall hold office for three years, starting
     7  on the first day of the first month following the member's
     8  appointment. A serving member of the board shall continue to
     9  serve following the expiration of the member's term until a
    10  successor takes office or a period of 90 days has elapsed,
    11  whichever occurs first.
    12     (d)  Midterm vacancies.--Midterm vacancies shall be filled by
    13  the same appointer and the individual appointed to fill a
    14  vacancy occurring prior to the expiration of the term for which
    15  a member is appointed shall hold office for the remainder of the
    16  predecessor's term.
    17     (e)  Compensation, benefits and expenses.--The executive
    18  director and members of the board shall receive an annual
    19  salary, benefits and expense reimbursement established by the
    20  board, to be paid from the trust. The initial board shall
    21  establish its own compensation. No increase or decrease in
    22  salary or benefits adopted by the board for the executive
    23  director or members shall become effective within the same
    24  three-year term.
    25     (f)  Meetings.--
    26         (1)  The executive director shall set the time, place and
    27     date for the initial and subsequent meetings of the board and
    28     shall preside over its meetings. The initial meeting shall be
    29     set not sooner than 50 nor later than 100 days after the
    30     appointment of the executive director. Subsequent meetings
    20070H1660B2195                  - 6 -     

     1     shall occur at least monthly thereafter.
     2         (2)  All meetings of the board are open to the public
     3     unless questions of patient confidentiality arise. The board
     4     may go into closed executive session with regard to issues
     5     related to confidential patient information.
     6     (g)  Quorum.--Two-thirds of the appointed members of the
     7  board shall constitute a quorum for the conducting of business
     8  at meetings of the board. Decisions at ordinary meetings of the
     9  board shall be reached by majority vote of those actually
    10  present or, in the event of emergency meeting, those also
    11  present by electronic or telephonic means. Where there is a tie
    12  vote, the executive director shall be granted an additional vote
    13  to break the tie.
    14     (h)  Ethics.--The executive director, the members and their
    15  immediate families are prohibited from having any pecuniary
    16  interest in any business with a contract or in negotiation for a
    17  contract with the agency. The board shall also adopt rules of
    18  ethics and definitions of irreconcilable conflicts of interest
    19  that will determine under what circumstances members must recuse
    20  themselves from voting.
    21     (i)  Prohibitions.--No member of the board, except for the
    22  executive director, who shall receive no additional salary or
    23  benefits by virtue of serving on the board, shall hold any other
    24  salaried Commonwealth public position, either elected or
    25  appointed, during the member's tenure on the board.
    26  Section 302.  Duties of board.
    27     (a)  General duties.--The board is responsible for directing
    28  the agency in the performance of all duties, the exercise of all
    29  powers, and the assumption and discharge of all functions vested
    30  in the agency. The board shall adopt and publish its rules and
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     1  procedures in the Pennsylvania Bulletin no later than 180 days
     2  after the first meeting of the board.
     3     (b)  Specific duties.--The duties and functions of the board
     4  include, but are not limited to, the following:
     5         (1)  Implementing statutory eligibility standards for
     6     benefits.
     7         (2)  Annually adopting a benefits package for
     8     participants of the plan.
     9         (3)  Acting directly or through one or more contractors
    10     as the single payer administrator for all claims for health
    11     care services made under the plan.
    12         (4)  At least annually reviewing the appropriateness and
    13     sufficiency of reimbursements.
    14         (5)  Providing for timely payments to participating
    15     providers through a structure that is well organized and that
    16     eliminates unnecessary administrative costs.
    17         (6)  Implementing standardized claims and reporting
    18     methods for use by the plan.
    19         (7)  Developing a system of centralized electronic claims
    20     and payments accounting.
    21         (8)  Establishing an enrollment system that will ensure
    22     that those who travel frequently and cannot read or speak
    23     English are aware of their right to health care and are
    24     formally enrolled in the plan.
    25         (9)  Reporting annually to the General Assembly and to
    26     the Governor, on or before the first day of October, on the
    27     performance of the plan, the fiscal condition of the plan,
    28     recommendations for statutory changes, the receipt of
    29     payments from the Federal Government, whether current year
    30     goals and priorities were met, future goals and priorities,
    20070H1660B2195                  - 8 -     

     1     and major new technology or prescription drugs that may
     2     affect the cost of the health care services provided by the
     3     plan.
     4         (10)  Administering the revenues of the trust.
     5         (11)  Obtaining appropriate liability and other forms of
     6     insurance to provide coverage for the plan, the board, the
     7     agency and their employees and agents.
     8         (12)  Establishing, appointing and funding appropriate
     9     staff, office space, equipment, training and administrative
    10     support for the agency throughout this Commonwealth, all to
    11     be paid from the trust.
    12         (13)  Administering aspects of the agency by taking
    13     actions that include, but are not limited to, the following:
    14             (i)  Establishing standards and criteria for the
    15         allocation of operating funds.
    16             (ii)  Meeting regularly to review the performance of
    17         the agency and to adopt and revise its policies.
    18             (iii)  Establishing goals for the health care system
    19         established pursuant to the plan in measurable terms.
    20             (iv)  Establishing Statewide health care databases to
    21         support health care services planning.
    22             (v)  Implementing policies and developing mechanisms
    23         and incentives to assure culturally and linguistically
    24         sensitive care.
    25             (vi)  Establishing rules and procedures for
    26         implementation and staffing of a no-fault compensation
    27         system for iatrogenic injuries or complications of care
    28         whereby a patient's condition is made worse or an
    29         opportunity for cure or improvement is lost due to the
    30         health care or medications provided or appropriate care
    20070H1660B2195                  - 9 -     

     1         not provided by participating providers under the plan.
     2             (vii)  Establishing standards and criteria for the
     3         determination of appropriate transitional support and
     4         training for residents of this Commonwealth who are
     5         displaced from work during the first two years of the
     6         implementation of the plan.
     7             (viii)  Evaluating the state of the art in proven
     8         technical innovations, medications and procedures and
     9         adopting policies to expedite the rapid introduction
    10         thereof in this Commonwealth.
    11             (ix)  Establishing methods for the recovery of costs
    12         for health care services provided pursuant to the plan to
    13         a beneficiary who is also covered under the terms of a
    14         policy of insurance, a health benefit plan or other
    15         collateral source available to the participant under
    16         which the participant has a right of action for
    17         compensation. Receipt of health care services pursuant to
    18         the plan shall be deemed an assignment by the participant
    19         of any right to payment for services from any such
    20         policy, plan or other source. The other source of health
    21         care benefits shall pay to the trust all amounts it is
    22         obligated to pay to, or on behalf of, the participant for
    23         covered health care services. The board may commence any
    24         action necessary to recover the amounts due.
    25         (14)  Recruiting the Health Advisory Panel of seven
    26     members made up of a cross section of the medical and
    27     provider community. The members of the advisory panel shall
    28     be paid a per diem rate, established by the board, for
    29     attendance at meetings and further be reimbursed for actual
    30     and necessary expenses incurred in the performance of their
    20070H1660B2195                 - 10 -     

     1     duties, which shall include:
     2             (i)  Advising the board on the establishment of
     3         policy on medical issues, population-based public health
     4         issues, research priorities, scope of services, expansion
     5         of access to health care services and evaluation of the
     6         performance of the plan.
     7             (ii)  Investigating proposals for innovative
     8         approaches to the promotion of health, the prevention of
     9         disease and injury, patient education, research and
    10         health care delivery.
    11             (iii)  Advising the board on the establishment of
    12         standards and criteria to evaluate requests from health
    13         care facilities for capital improvements.
    14             (iv)  Evaluating and advising the board on requests
    15         from providers, or their representatives, for adjustments
    16         to reimbursements.
    17         (15)  Establishing a secure and centralized electronic
    18     health record system wherein a beneficiary's entire health
    19     record can be readily and reliably accessed by authorized
    20     persons with the objective of eliminating the errors and
    21     expense associated with paper records and diagnostic films.
    22                            SUBCHAPTER B
    24  Section 321.  Pennsylvania Health Care Agency.
    25     (a)  Establishment of agency.--There is hereby established
    26  the Pennsylvania Health Care Agency. The agency shall administer
    27  the plan and is the sole agency authorized to accept applicable
    28  grants-in-aid from the Federal Government and State government.
    29  It shall use such funds in order to secure full compliance with
    30  provisions of Federal and State law and to carry out the
    20070H1660B2195                 - 11 -     

     1  purposes established under this act. All grants-in-aid accepted
     2  by the agency shall be deposited into the Pennsylvania Health
     3  Care Trust Fund established under this act, together with other
     4  revenues raised within this Commonwealth to fund the plan.
     5     (b)  Appointment of executive director.--The executive
     6  director of the agency shall be appointed by the Governor for a
     7  term of three years and is the chief administrator of the plan.
     8     (c)  Personnel and employees.--The board shall employ and fix
     9  the compensation of agency personnel as needed by the agency to
    10  properly discharge the agency's duties. The employment of
    11  personnel by the board is subject to the civil service laws of
    12  this Commonwealth. The board shall employ personnel including,
    13  but not limited to, the following leadership positions, all of
    14  whom will report to the executive director of the agency:
    15         (1)  Administrator for planning, research and
    16     development.
    17         (2)  Administrator for finance.
    18         (3)  Administrator for quality assurance.
    19         (4)  Administrator for consumer affairs and health
    20     education.
    21         (5)  Administrator of health claims.
    22         (6)  Administrator for volunteer services.
    23         (7)  Administrator for provider coordination.
    24         (8)  Administrator for law.
    25         (9)  Administrator of transition services until the
    26     termination of this position on December 31, 2012.
    27         (10)  Beneficiary advocate.
    28  Section 322.  Executive director duties.
    29     The executive director shall oversee the operation of the
    30  agency and the agency's performance of any duties assigned by
    20070H1660B2195                 - 12 -     

     1  the board.
     2  Section 323.  Administrator for planning, research and
     3                 development.
     4     The executive director of the agency shall determine the
     5  duties of the administrator of planning, research and
     6  development. Those duties shall include, but not be limited to,
     7  the following:
     8         (1)  Establishing policy on medical issues, population-
     9     based public health issues, research priorities, scope of
    10     services, the expansion of participants' access to health
    11     care services and the evaluation of the performance of the
    12     plan.
    13         (2)  Investigating proposals for innovative approaches
    14     for the promotion of health, the prevention of disease and
    15     injury, patient education, research and the delivery of
    16     health care services.
    17         (3)  Establishing standards and criteria for evaluating
    18     applications from health care facilities for capital
    19     improvements.
    20         (4)  Evaluating environmental risks and coordinating
    21     agency policy with other governmental and nongovernmental
    22     entities committed to assuring health by reducing
    23     environmental hazards.
    24  Section 324.  Administrator for consumer affairs and health
    25                 education.
    26     The executive director of the agency shall determine the
    27  duties of the administrator for consumer affairs and health
    28  education. Those duties shall include, but not be limited to,
    29  the following:
    30         (1)  Developing educational and informational guides for
    20070H1660B2195                 - 13 -     

     1     consumers that describe consumer rights and responsibilities
     2     and that inform consumers of effective ways to exercise
     3     consumer rights to obtain health care services. The guides
     4     shall be easy to read and understand and available in English
     5     and in other languages. The agency shall make the guide
     6     available to the public through public outreach and
     7     educational programs and through the Internet website of the
     8     agency.
     9         (2)  Establishing a toll-free telephone number to receive
    10     questions and complaints regarding the agency and the
    11     agency's services. The agency's Internet website shall
    12     provide complaint forms and instructions online.
    13         (3)  Examining suggestions from the public.
    14         (4)  Making recommendations for improvements to the
    15     board.
    16         (5)  Examining the extent to which individual health care
    17     facilities in a region meet the needs of the community in
    18     which they are located.
    19         (6)  Receiving, investigating and responding to all
    20     consumer complaints about any aspect of the plan and, where
    21     appropriate, referring the results of all investigations of
    22     questioned care to the appropriate provider or health care
    23     facility licensing board or, in cases of possible violation
    24     of law, to a law enforcement agency.
    25         (7)  Publishing an annual report for the public, the
    26     Governor and the General Assembly that contains a Statewide
    27     evaluation of the agency.
    28         (8)  Holding public hearings in each congressional
    29     district, at least annually, for public input.
    30  Section 325.  Administrator for quality assurance.
    20070H1660B2195                 - 14 -     

     1     The executive director of the agency shall determine the
     2  duties of the administrator of quality assurance. Those duties
     3  shall include, but not be limited to, the following:
     4         (1)  Studying and reporting on the efficacy of health
     5     care treatments and medications for particular conditions.
     6         (2)  Identifying causes of medical errors and devising
     7     procedures to reduce their frequency.
     8         (3)  Establishing an evidence-based formulary.
     9         (4)  Identifying treatments and medications that are
    10     unsafe or have no proven value.
    11         (5)  Establishing a process for soliciting information on
    12     medical standards from providers and consumers for purposes
    13     of this section.
    14         (6)  Independently reviewing all claims submitted to the
    15     administrator of health claims to determine if correctable
    16     errors have occurred or whether there are patterns of errors
    17     or complications which require closer investigation,
    18     evaluation and correction, and then to assure all such
    19     appropriate measures are recommended in writing to the
    20     executive director.
    21  Section 326.  Administrator for finance.
    22     The executive director of the agency shall determine the
    23  duties of the administrator of finance. Those duties shall
    24  include, but not be limited to, the following:
    25         (1)  Administering the trust.
    26         (2)  Making payments to participating providers within
    27     five business days of submission and to other providers
    28     within 30 days of submission.
    29         (3)  Developing a system of simplified, secure and
    30     centralized electronic claims and payments employing the best
    20070H1660B2195                 - 15 -     

     1     technology with assured backup and catastrophe recovery
     2     contingencies and facilities.
     3         (4)  Communicating to the State Treasurer when funds are
     4     needed from the trust for the operation of the plan.
     5         (5)  Developing information systems for utilization
     6     review.
     7         (6)  Investigating and recommending for appropriate civil
     8     and/or criminal prosecution possible provider or consumer
     9     fraud.
    10  Section 327.  Administrator for claims.
    11     The executive director of the agency shall determine the
    12  duties of the administrator of claims. Those duties shall
    13  include, but not be limited to, the following:
    14         (1)  Establishing a system of administrative procedures,
    15     health claim hearing officers and appeal panel for the
    16     processing of patient claims.
    17         (2)  Supervising the health claims hearing officers to
    18     assure swift and fair processing of claims.
    19         (3)  Reviewing all appeals from the determinations of the
    20     health claims hearing officers, and then advising the
    21     executive director who shall then make the final agency
    22     determination.
    23         (4)  Supervising follow-up oversight of awarded claims to
    24     determine when or if adjustments to the awarded compensation
    25     is appropriate given improvement in the awardee's condition
    26     and if so to initiate appropriate review procedures before
    27     the health claims hearing officers.
    28  Section 328.  Administrator for volunteer services.
    29     The executive director of the agency shall determine the
    30  duties of the administrator for volunteer services. Those duties
    20070H1660B2195                 - 16 -     

     1  shall include, but not be limited to, the following:
     2         (1)  Coordinating with the State Treasurer to establish
     3     procedures necessary to implement the volunteer tax rebate
     4     provisions of this act.
     5         (2)  Investigating the status of volunteerism in this
     6     Commonwealth in firefighting, search and rescue, emergency
     7     response and otherwise as it pertains to the health of
     8     Pennsylvanians and the means by which citizens can be
     9     encouraged to volunteer.
    10         (3)  Developing programs to encourage blood and organ
    11     donation in this Commonwealth.
    12         (4)  Making recommendations to the executive director and
    13     the board for programs and initiatives that will best support
    14     and encourage health-related volunteerism in this
    15     Commonwealth.
    16  Section 329.  Administrator for provider coordination.
    17     The executive director of the agency shall determine the
    18  duties of the administrator for provider coordination. Those
    19  duties shall include, but not be limited to, all of the
    20  following:
    21         (1)  Processing all applications for participating
    22     provider status.
    23         (2)  Assisting participating providers in their efforts
    24     to meet the qualification requirements established by the
    25     board.
    26         (3)  Establishing an inquiry office to assist
    27     participating providers with regard to proper submission of
    28     requests for reimbursements.
    29  Section 330.  Administrator for law.
    30     The executive director of the agency shall determine the
    20070H1660B2195                 - 17 -     

     1  duties of the administrator for law. Those duties shall include,
     2  but not be limited to, the following:
     3         (1)  Establishing, supervising and maintaining a team of
     4     legal professionals as necessary to support all of the legal
     5     representation needs of the agency.
     6         (2)  Defending the interests of the plan before the
     7     health claims hearing officers and before the courts against
     8     nonmeritorious claims.
     9         (3)  Representing the board in disciplinary actions
    10     against participating providers.
    11         (4)  Serving as the principal ethics officer for the
    12     agency.
    13  Section 331.  Administrator for transition services.
    14     The executive director of the agency shall determine the
    15  duties of the administrator of transition services. Those duties
    16  shall include, but not be limited to, the following:
    17         (1)  Establishing procedures for identifying
    18     Pennsylvanians whose livelihood will be detrimentally
    19     affected by the passage of this act.
    20         (2)  Establishing procedures to most efficiently and
    21     effectively transition such persons into positions with the
    22     agency where appropriate or to other health-related fields
    23     where the passage of this act will create an immediate need
    24     for qualified employees.
    25         (3)  Reporting to the administrator of finance with
    26     respect to the financial requirements to support the eligible
    27     displaced citizens and to assist in the filing for
    28     transitional wage replacement benefits approved by the board.
    29         (4)  Planning for the discontinuance of this division of
    30     the board on December 31, 2012.
    20070H1660B2195                 - 18 -     

     1  Section 332.  Administrator for beneficiary advocate.
     2     The executive director of the agency shall determine the
     3  duties of the beneficiary advocate. Those duties shall include,
     4  but not be limited to, the following:
     5         (1)  Establishment of a readily accessible beneficiary
     6     telephone and Internet website resource in instances where
     7     they are having difficulties securing necessary care through
     8     the plan. This office shall make immediate inquiries to
     9     ascertain the nature of the difficulties and to resolve the
    10     beneficiary's problem.
    11         (2)  Where a beneficiary seeks specialized care from
    12     outside this Commonwealth and from other than a participating
    13     provider, the beneficiary advocate shall assist in the proper
    14     application for an extension of benefits on behalf of the
    15     beneficiary.
    16         (3)  Management of death claim dependent trusts.
    17                            SUBCHAPTER C
    18                             (Reserved)
    19                            SUBCHAPTER D
    20                             (Reserved)
    21                            SUBCHAPTER E
    22                             (Reserved)
    23                            SUBCHAPTER F
    24                              IMMUNITY
    25  Section 371.  Immunity.
    26     In the absence of fraud or bad faith, the advisory panel, the
    27  board and agency and their respective members and employees
    28  shall incur no liability in relation to the performance of their
    29  duties and responsibilities under this act. The Commonwealth
    30  shall incur no liability in relation to the implementation and
    20070H1660B2195                 - 19 -     

     1  operation of the plan.
     2                             CHAPTER 5
     3                   PENNSYLVANIA HEALTH CARE PLAN
     4  Section 501.  General provisions.
     5     (a)  Establishment of plan.--There is hereby established the
     6  Pennsylvania Health Care Plan that shall be administered by the
     7  independent Pennsylvania Health Care Agency under the direction
     8  of the Pennsylvania Health Care Board.
     9     (b)  Coverage.--The plan shall provide health care coverage
    10  for all citizens of this Commonwealth and for certain eligible
    11  visitors. The agency shall work simultaneously to control health
    12  care costs, achieve measurable improvement in health care
    13  outcomes, promote a culture of health awareness, increase
    14  satisfaction with the health care system, adopt an optional no-
    15  fault administrative system to fairly compensate those whose
    16  conditions are made worse by the treatments they receive or
    17  through failures to receive appropriate care, implement policies
    18  that strengthen and improve culturally sensitive care, and
    19  develop an integrated health care database to support health
    20  care planning and quality assurance.
    21     (c)  Reforms.--The board shall implement the reforms adopted
    22  by the General Assembly hereby on January 1, 2008.
    23  Section 502.  Universal health care access eligibility.
    24     (a)  Eligibility.--All Pennsylvania citizens, including
    25  documented aliens, full-time out-of-State students attending
    26  school in this Commonwealth, homeless persons and migrant
    27  agricultural workers and their accompanying families are
    28  eligible beneficiaries under the plan. The board shall establish
    29  standards and a simple procedure to demonstrate proof of
    30  eligibility.
    20070H1660B2195                 - 20 -     

     1     (b)  Enrollment.--Enrollment in the plan shall be automatic
     2  and beneficiaries shall be provided with access cards with
     3  appropriate proof of identity technology and privacy protection.
     4  Individuals covered under a collective bargaining agreement that
     5  provides health benefits at least as extensive as the plan, as
     6  certified by the executive director, shall not be eligible for
     7  plan benefits.
     8     (c)  Waivers.--If waivers are not obtained from the medical
     9  assistance and/or Medicare programs operated under Title XVIII
    10  or XIX of the Social Security Act (49 Stat. 620, 42 U.S.C. § 301
    11  et seq.), the medical assistance and Medicare nonwaived programs
    12  shall act as the primary insurers for those eligible for such
    13  coverage, and the plan shall serve as the secondary or
    14  supplemental plan of health coverage. Until such time as waivers
    15  are obtained, the plan will not pay for services for persons
    16  otherwise eligible for the same benefits under Medicare or
    17  Medicaid. The plan shall also be secondary to benefits provided
    18  to military veterans except where reasonable and timely access,
    19  as defined by the board, is denied or unavailable through the
    20  United States Veterans' Administration, in which instance the
    21  plan will be primary and will seek reasonable reimbursement from
    22  the United States Veterans' Administration for the services
    23  provided to veterans.
    24     (d)  Priority of plans.--A plan of employee health coverage
    25  provided by an out-of-State employer to a Pennsylvania resident
    26  working outside of this Commonwealth shall serve as the
    27  employee's primary plan of health coverage, and the plan shall
    28  serve as the employee's secondary plan of health coverage.
    29     (e)  Reimbursement.--The plan shall reimburse participating
    30  providers practicing outside of this Commonwealth at plan rates,
    20070H1660B2195                 - 21 -     

     1  or reasonable locally prevailing rate, for health care services
     2  rendered to a beneficiary while the beneficiary is out of this
     3  Commonwealth. Services provided to a beneficiary out of this
     4  Commonwealth by other than a participating provider shall be
     5  reimbursed to the beneficiary or to the provider at a fair and
     6  reasonable rate for that location.
     7     (f)  Presumption of eligibility.--Any individual who arrives
     8  at a health care facility unconscious or otherwise unable due to
     9  their mental or physical condition to document eligibility for
    10  coverage shall be presumed to be eligible, and emergency care
    11  shall be provided without delay occasioned over issues of
    12  ability to pay.
    13     (g)  Rules.--The board shall adopt rules assuring that any
    14  participating provider who renders humanitarian emergency or
    15  urgent care within this Commonwealth to a not actually eligible
    16  recipient shall nevertheless be reimbursed for such care from
    17  the plan subject to such rules as will reasonably limit the
    18  frequency of such events to protect the fiscal integrity of the
    19  plan. It shall be the agency's responsibility to secure
    20  reimbursement for the costs paid for such care from any
    21  appropriate third party funding source, or from the individual
    22  to whom the services were rendered.
    23  Section 503.  Covered services.
    24     (a)  Benefits package.--The board shall establish a single
    25  health benefits package within the plan that shall include, but
    26  not be limited to, all of the following:
    27         (1)  Inpatient and outpatient care, both primary and
    28     secondary.
    29         (2)  Emergency services.
    30         (3)  Emergency and other medically necessary transport to
    20070H1660B2195                 - 22 -     

     1     covered health services.
     2         (4)  Rehabilitation services, including speech,
     3     occupational and physical therapy.
     4         (5)  Inpatient and outpatient mental health services and
     5     substance abuse treatment.
     6         (6)  Hospice care.
     7         (7)  Prescription drugs and prescribed medical nutrition.
     8         (8)  Vision care, aids and equipment.
     9         (9)  Hearing care, hearing aids and equipment.
    10         (10)  Diagnostic medical tests, including laboratory
    11     tests and imaging procedures.
    12         (11)  Medical supplies and prescribed medical equipment.
    13         (12)  Immunizations, preventive care, health maintenance
    14     care and screening.
    15         (13)  Dental care.
    16         (14)  Home health care services.
    17         (15)  Chiropractic and massage therapy.
    18         (16)  Long-term care for those unable to care for
    19     themselves independently and including assisted and skilled
    20     care.
    21     (b)  Exclusions for preexisting conditions.--The plan shall
    22  not exclude or limit coverage due to preexisting conditions.
    23     (c)  Copayments, deductibles, etc.--Beneficiaries of the plan
    24  are not subject to copayments, deductibles, point-of-service
    25  charges or any other fee or charge for a service within the
    26  package and shall not be directly billed nor balance billed by
    27  participating providers for covered benefits provided to the
    28  beneficiary. Where a beneficiary has directly paid for
    29  nonemergency services of a nonparticipating provider, the
    30  beneficiary may submit a claim for reimbursement from the plan
    20070H1660B2195                 - 23 -     

     1  for the amount the plan would have paid a participating provider
     2  for the same service. Where emergency services are rendered by a
     3  nonparticipating provider, the beneficiary shall receive
     4  reimbursement of the full amount paid to such nonparticipating
     5  provider not to exceed 125% of the amount the plan would have
     6  paid a participating provider for the same service.
     7     (d)  Exclusions of coverage.--The board shall remove or
     8  exclude procedures and treatments, equipment and prescription
     9  drugs from the plan benefit package that the board finds unsafe
    10  or that add no therapeutic value.
    11     (e)  The board shall exclude coverage for any surgical,
    12  orthodontic or other procedure or drug that the board determines
    13  was or will be provided primarily for cosmetic purposes unless
    14  required to correct a congenital defect, to restore or correct
    15  disfigurements resulting from injury or disease or that is
    16  certified to be medically necessary by a qualified, licensed
    17  provider.
    18     (f)  Choice by beneficiary.--Beneficiaries shall normally be
    19  granted free choice of the participating providers, including
    20  specialists, without preapprovals or referrals. However, the
    21  board shall adopt procedures to restrict such free choice for
    22  those individuals who engage in patterns of wasteful or abusive
    23  self-referrals to specialists. Specialists who provide primary
    24  care to a self-referred beneficiary will be reimbursed at the
    25  board-approved primary care rate established for the service in
    26  that community.
    27     (g)  Service.--No participating provider shall be compelled
    28  to offer any particular service so long as the refusal is
    29  general, consistent and not discriminatory.
    30     (h)  Discrimination.--The plan and participating providers
    20070H1660B2195                 - 24 -     

     1  shall not discriminate on the basis of race, ethnicity, national
     2  origin, gender, age, religion, sexual orientation, health
     3  status, mental or physical disability, employment status,
     4  veteran status or occupation.
     5  Section 504.  Excess and collective bargaining agreement health
     6                 insurance coverage.
     7     Subject to the regulations of the Insurance Commissioner and
     8  all applicable laws, private health insurers shall be authorized
     9  to offer coverage supplemental to the package approved and
    10  provided automatically under this act.  Private insurers shall
    11  also be authorized to offer programs to support the health care
    12  terms of a collective bargaining agreement provided that such
    13  benefits are at least as comprehensive as those provided under
    14  the plan.
    15  Section 505.  Duplicate coverage.
    16     The agency is subrogated to and shall be deemed an assignee
    17  of all rights of a beneficiary who has received duplicate health
    18  care benefits, or who has a right to such benefits, under any
    19  other policy or contract of health care or under any government
    20  program.
    21  Section 506. Subrogation.
    22     (a)  General rule.--The agency shall have no right of
    23  subrogation against a beneficiary's third-party claims for harm
    24  or losses not covered under this act. Nor shall any beneficiary
    25  under this act have a claim against a third-party tortfeasor for
    26  the services provided or available to the beneficiary under this
    27  act. In all personal injury actions accruing and prosecuted by a
    28  beneficiary on or after January 1, 2008, the presiding judge
    29  shall advise any jury that all health care expenses have been or
    30  will be paid under the plan, and, therefore, no claim for past
    20070H1660B2195                 - 25 -     

     1  or future health care benefits is pending before the court.
     2     (b)  Exception.--The exception to the general rule of no
     3  subrogation shall be that the agency retains its equitable right
     4  to subrogation to the recovery, including the recovery for
     5  noneconomic damages, of those persons opting out of the no-fault
     6  administrative remedies adopted herein and who successfully
     7  prosecute to verdict or settlement a claim for health care
     8  professional or institutional negligence. The agency's right to
     9  subrogation shall be absolute and shall not be subject to
    10  reduction for attorney fees or costs of litigation.
    11  Section 507.  Eligible participating providers and availability
    12                 of services.
    13     (a)  General rule.--All licensed health care providers and
    14  facilities are eligible to become a participating provider in
    15  the plan in which instance they shall enjoy the rights and have
    16  the duties as set forth in the plan as stated in this section or
    17  as adopted by the board from time to time. Nonparticipating
    18  providers shall not enjoy the rights nor bear the duties of
    19  participating providers.
    20     (b)  Required notice.--In advance of initially providing
    21  services to a beneficiary, nonparticipating providers shall
    22  advise the beneficiary at the time the appointment is made that
    23  the person or entity is a nonparticipating provider and that the
    24  recipient of the service will be initially personally
    25  responsible for the entire cost of the service and ultimately
    26  responsible for the cost in excess of the reimbursement approved
    27  by the board for participating providers. Failure to make such
    28  financial disclosure will be deemed a fraud on the beneficiary
    29  and entitle the beneficiary to a refund equal to 200% of the
    30  amount paid to the nonparticipating provider in excess of the
    20070H1660B2195                 - 26 -     

     1  board-approved reimbursement for the services rendered, plus all
     2  reasonable fees for collection. The burden of proof that such
     3  disclosure was made shall be on the nonparticipating provider.
     4     (c)  Plan by board.--The board shall assess the number of
     5  primary and specialty providers needed to supply adequate health
     6  care services in this Commonwealth generally and in all
     7  geographic areas and shall develop a plan to meet that need. The
     8  board shall develop financial incentives for participating
     9  providers in order to maintain and increase access to health
    10  care services in underserved areas of this Commonwealth.
    11     (d)  Reimbursements.--Reimbursements shall be determined by
    12  the board in such a fashion as to assure that a participating
    13  provider receives compensation for services that fairly and
    14  fully reflect the skill, training, operating overhead included
    15  in the costs of providing the service, capital costs of
    16  facilities and equipment, cost of consumables and the expense of
    17  safely discarding medical waste, plus a reasonable profit
    18  sufficient to encourage talented individuals to enter the field
    19  and for investors to make capital available for the construction
    20  of state-of-the-art health care facilities in this Commonwealth.
    21     (e)  Adjustments to reimbursements.--Participating providers
    22  shall have the right alone or collectively to petition the board
    23  for adjustments to reimbursements believed to be too low. Such
    24  petitions shall be initially evaluated by the administrator of
    25  provider services, with input from the Health Advisory Panel,
    26  who shall submit a report to the executive director within 30
    27  days. The executive director will then submit a recommendation
    28  to the board for action at the next scheduled board meeting.
    29  Participating providers who remain dissatisfied after the board
    30  has ruled may appeal the board's determination to the Court of
    20070H1660B2195                 - 27 -     

     1  Common Pleas of Dauphin County, which shall review the action of
     2  the board on an abuse of discretion standard.
     3     (f)  Evaluation of access to care.--The board annually shall
     4  evaluate access to trauma care, diagnostic imaging technology,
     5  emergency transport and other vital urgent care requirements and
     6  shall establish measures to assure beneficiaries have equitable
     7  and ready access to such resources regardless of where in this
     8  Commonwealth they may be.
     9     (g)  Performance reports.--The board, with the assistance of
    10  the Health Advisory Panel and the administrator of quality
    11  assurance, shall define performance criteria and goals for the
    12  plan and shall make a written report to the General Assembly at
    13  least annually on the plan's performance. All such reports,
    14  including the survey results obtained, shall be made publicly
    15  available with the goal of total transparency and open self-
    16  analysis as a defining quality of the agency. The board shall
    17  establish a system to monitor the quality of health care and
    18  patient and provider satisfaction and to adopt a system to
    19  devise improvements and efficiencies to the provision of health
    20  care services.
    21     (h)  Data reporting.--All participating providers shall
    22  provide data to the agency promptly upon the request of the
    23  executive director.
    24     (i)  Coordination of services.--The board shall coordinate
    25  the provision of health care services with any other
    26  Commonwealth and local agencies that provide health care
    27  services directly to their charges or residents.
    28  Section 508.  Rational cost containment.
    29     (a)  Approval of expenditures.--As part of its cost
    30  containment mission, the board shall screen and approve or
    20070H1660B2195                 - 28 -     

     1  disapprove private or public expenditures for new health care
     2  facilities and other capital investments that may lead to
     3  redundant and inefficient health care provider capacity.
     4  Procedures shall be adopted for this purpose with an emphasis
     5  upon efficiency and a fair and open consideration of all
     6  applications.
     7     (b)  Capital investments.--All capital investments valued at
     8  one million dollars or greater, including the costs of studies,
     9  surveys, design plans and working drawing specifications, and
    10  other activities essential to planning and execution of capital
    11  investment and all capital investments that change the bed
    12  capacity of a health care facility by more than 10% over a 24-
    13  month period or that add a new service or license category shall
    14  require the approval of the board. When a facility, an
    15  individual acting on behalf of a facility or any other purchaser
    16  obtains by lease or comparable arrangement any facility or part
    17  of a facility, or any equipment for a facility, the market value
    18  of which would have been a capital expenditure, the lease or
    19  arrangement shall be considered a capital expenditure for
    20  purposes of this section.
    21     (c)  Deemed approval.--Capital investment programs submitted
    22  for approval shall be deemed approved unless specifically
    23  rejected by the board within 60 days from the date the
    24  submissions are received by the executive director.
    25     (d)  Recommendations.--Recommendations of the Pennsylvania
    26  Heath Cost Containment Council, Pittsburgh Regional Health Care
    27  Initiative and such other public and private authoritative
    28  bodies as shall be identified from time to time by the board
    29  shall be received by the executive director and submitted to the
    30  board with the executive director's recommendation regarding
    20070H1660B2195                 - 29 -     

     1  implementation of the recommended reforms. The board shall
     2  receive input from all interested parties and then shall vote
     3  upon all such recommendations within 60 days. Where procedural
     4  or protocol reforms are adopted, participating providers will be
     5  required to implement such designated best practices within the
     6  next 60 days.
     7     (e)  Required investments.--If mandated reforms require the
     8  acquisition of additional equipment, participating providers
     9  shall make such investments within one year, and, upon
    10  application, the board shall provide financing for such mandated
    11  equipment on reasonable terms.
    12     (f)  Sanctions.--Participating providers refusing to adopt
    13  recommended reforms shall, after a reasonable opportunity to be
    14  heard, be subject to such sanctions as the board shall deem
    15  appropriate and necessary up to and including the suspension or
    16  permanent decertification of the provider.
    17                             CHAPTER 7
    19  Section 701.  Rationalization of remedies for errors and
    20                 complications.
    21     A primary objective of the board shall be to reduce the
    22  frequency of medical errors and complications and to establish a
    23  no-fault administrative procedure for fair and expeditious
    24  compensation to those who suffer injuries or complications
    25  relating to their care.
    26  Section 702.  Voluntary waiver of tort remedies and choice to
    27                 retain tort remedies.
    28     Beneficiaries under the plan shall be conclusively deemed to
    29  have voluntarily waived all other common law and statutory tort
    30  remedies against any participating provider for alleged
    20070H1660B2195                 - 30 -     

     1  professional negligence, error of judgment or failure to secure
     2  informed consent. Beneficiaries under the plan not willing to
     3  waive such common law and statutory remedies may opt out of the
     4  no-fault administrative remedies set forth in this act at any
     5  time prior to the events complained of. Nonparticipating
     6  providers shall not fall within the protections of the waiver of
     7  tort remedies.
     8  Section 703.  No-fault administrative remedies for those not
     9                 opting out.
    10     (a)  Compensation.--In exchange for the waiver of their
    11  traditional tort remedies, beneficiaries who suffer a new injury
    12  or complication directly related to the care provided by, or
    13  medications or treatments prescribed by a participating provider
    14  shall be entitled to expedited compensation without proof of
    15  professional negligence or error of judgment. Where the
    16  application for compensation does not arise from a new injury or
    17  complication but rather asserts a failure of a participating
    18  provider to properly intervene, and thus mitigate the natural
    19  progress of a disease or injury, proof of a departure from the
    20  standard of care must be demonstrated by a preponderance of the
    21  credible evidence for the claimant to qualify for compensation.
    22  Out-of-state patients seeking care in Pennsylvania from a
    23  participating provider shall, prior to treatment unless
    24  unconscious or other circumstances prevent it, be provided with
    25  a form approved by the board on which the patient can opt in or
    26  opt out of the no-fault administrative remedies. Where no
    27  election is made, the patient shall be conclusively presumed to
    28  have chosen to participate in the no-fault administrative
    29  remedies should the occasion arise.
    30     (b)  Other compensation.--In further exchange for the waiver
    20070H1660B2195                 - 31 -     

     1  of their traditional tort remedies, beneficiaries not opting out
     2  of the no-fault administrative remedies and who assert that they
     3  did not give their informed consent to an invasive procedure or
     4  treatment, but who have not suffered a new injury or
     5  complication thereby, shall be entitled to compensation upon
     6  proof of the failure of the participating provider, or the
     7  provider's representative, to provide at least the level of
     8  information required for the procedure at issue pursuant to
     9  guidelines adopted by the board.
    10     (c)  Award of damages.--Eligible claimants not opting out of
    11  the no-fault administrative remedies shall be entitled to awards
    12  to be determined by the health claims hearing officers as
    13  follows:
    14         (1)  For past and/or continuing lost earning capacity, up
    15     to a maximum of $5,000 per month.
    16         (2)  For noneconomic harm, defined as past and/or
    17     continuing pain, suffering, disfigurement and/or
    18     inconvenience, up to a maximum of $5,000 per month.
    19         (3)  For a failure of informed consent, either alone or
    20     in conjunction with an award for past and or continuing lost
    21     earning capacity and/or noneconomic harm, a maximum single
    22     lump-sum payment of $10,000.
    23         (4)  For death, and in addition to the lost earning
    24     capacity and noneconomic harm endured prior to death, up to a
    25     maximum of $10,000 per month for 120 months to be placed in
    26     trust for the benefit of the decedent's dependents. The trust
    27     shall be managed by the office of the beneficiary advocate
    28     under guidelines adopted by the board.
    29     (d)  Adjustments of limits.--The board shall adjust the
    30  limits of compensation annually to account for inflation, and
    20070H1660B2195                 - 32 -     

     1  all awards for continuing lost earning capacity and/or
     2  noneconomic damages shall be adjusted annually at the same rate
     3  of inflation as determined by the board.
     4     (e)  Payment from trust.--The cost of all such compensation
     5  shall be paid from the trust. No participating provider shall be
     6  held financially responsible for any portion of the compensation
     7  award nor shall participating providers be required to fund the
     8  cost of such awards collectively through any assessment or
     9  premium.
    10  Section 704.  Administrative claims procedures.
    11     (a)  Application for compensation.--The board shall adopt
    12  simplified procedures for the submission of applications for no-
    13  fault compensation under this act to the administrator of health
    14  claims. The procedures shall provide for the expeditious
    15  handling and approval of any clearly qualifying claims. Where
    16  fact-finding is required in whole or in part, such claims shall
    17  be presented expeditiously to a health claims hearing officer
    18  for findings. Administrative appeals to the executive director
    19  shall be permitted, and, where a claimant has been denied
    20  compensation or contests the sufficiency of the award, claimant
    21  shall have an appeal to the Court of Common Pleas of Dauphin
    22  County which will consider the adequacy of the compensation on a
    23  de novo basis with the power to increase or decrease the amount
    24  awarded administratively. However, such court shall not have the
    25  power to award compensation in excess of the limits established
    26  by this act.
    27     (b)  Attorney fees.--Where on appeal to the Court of Common
    28  Pleas of Dauphin County a denied claim is approved or an
    29  administrative award is increased by at least 25%, the court
    30  shall also award a reasonable attorney fee of no more than 20%
    20070H1660B2195                 - 33 -     

     1  and all reasonable litigation expenses including the cost of
     2  expert witnesses and exhibits.
     3     (c)  Adjustment of awards.--The board shall further adopt
     4  procedures whereby awards granted under this section for
     5  continuing harms shall be subject to increase, not to exceed the
     6  limits, or decrease upon a showing of a material change in the
     7  claimant's condition. Continuing benefits shall be contingent
     8  upon the reasonable cooperation of the claimant with respect to
     9  the rehabilitation and mitigation of the claimant's injury.
    10     (d)  Administrative procedure.--The board shall adopt
    11  administrative procedure to review appeals of participating
    12  providers with respect to denials or adjustment of reimbursement
    13  which appeals must be filed within 90 days of the notice of a
    14  denied or adjusted reimbursement.
    15  Section 705.  Beneficiary right to counsel.
    16     (a)  Choice of counsel.--Beneficiaries seeking to file a
    17  claim for no-fault compensation under this act shall have the
    18  right to be represented by legal counsel of their choice.
    19     (b)  Fee agreement.--Any contingent fee agreement entered
    20  into between a beneficiary claimant and their legal counsel
    21  shall be limited as follows:
    22         (1)  Five percent where the claim is administratively
    23     approved without a hearing.
    24         (2)  Ten percent where the claim proceeds to a hearing.
    25         (3)  Twenty percent where the claim is resolved after
    26     appeal.
    27  Section 706.  Quality assurance follow-up to claims.
    28     (a)  Investigations.--All claims of error, complication or
    29  failure of informed consent shall simultaneously be submitted
    30  for analysis and quality assurance investigation through the
    20070H1660B2195                 - 34 -     

     1  office of the administrator for quality assurance. The
     2  beneficiary submitting the claim shall be advised of the
     3  progress of the inquiry and invited to present such information
     4  or testimony as they deem necessary to the full and fair
     5  consideration of the matters reported. Beneficiaries may attend
     6  and/or be represented during this process by counsel of their
     7  choosing at their own expense or may request the assistance at
     8  no cost of a qualified advocate from the office of the
     9  administrator of consumer affairs.
    10     (b)  Representation of providers.--Participating providers
    11  who are the subject of an inquiry initiated by a beneficiary
    12  application for compensation may attend and/or be represented by
    13  counsel of their choosing at their own expense or may request
    14  the assistance at no cost of a qualified advocate from the
    15  office of the administrator for provider coordination.
    16     (c)  Reports.--At the conclusion of the inquiry, the
    17  administrator of quality assurance shall submit a report and
    18  recommendations to the executive director who shall then take
    19  such action as they deem necessary under the circumstances to
    20  avoid a recurrence of any avoidable errors. A copy of the
    21  recommendations shall be provided to the beneficiary who
    22  initiated the claim and also to the participating provider
    23  involved in the inquiry. The report will be forwarded to
    24  appropriate licensing authorities for further action.
    25  Section 707.  Surviving tort claims against participating
    26                 providers.
    27     (a)  Optional remedies.--Otherwise eligible persons who have
    28  opted out of the no-fault administrative remedies of the plan
    29  shall retain their right to pursue traditional tort remedies
    30  against participating providers through the courts of this
    20070H1660B2195                 - 35 -     

     1  Commonwealth and, where jurisdictional requirements are
     2  satisfied, through the courts of the United States.
     3     (b)  Legal counsel.--In all such cases participating
     4  providers shall have the right to legal counsel of their choice
     5  the reasonable cost of which shall be paid by the plan as will
     6  the reasonable cost of experts and other trial expenses. In the
     7  event of a final award in favor of the persons filing the claim,
     8  the plan shall further provide primary indemnification of up to
     9  three million dollars per claim and six million dollars per
    10  annual aggregate claims per participating provider.
    11     (c)  Excess liability coverage.--In the event the private
    12  insurance market does not make excess coverage available to
    13  participating providers at reasonable cost, the board shall
    14  recommend to the General Assembly the establishment of an excess
    15  liability insurance pool sponsored by the Commonwealth and
    16  financed with premiums to be paid by those participating
    17  providers who seek additional protection above and beyond the
    18  protection provided in subsection (b).
    19  Section 708.  Claims against nonparticipating providers.
    20     Health care providers opting out of the plan shall be
    21  responsible for the cost of their legal defense and shall be
    22  further responsible to the patient and/or the plan for any
    23  settlement or award, if any. Where the plan has paid for health
    24  care-related costs arising from an alleged failure of due care
    25  by a nonparticipating provider and where the injured party has
    26  otherwise been made whole, the plan shall be subrogated to the
    27  claim to the extent of the medical expenses incurred or that
    28  have been found will be incurred.
    29  Section 709.  Parallel no-fault compensation for beneficiaries
    30                 injured by nonparticipating providers.
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     1     Beneficiaries who have not opted out of the no-fault
     2  administrative remedies pursuant to section 702, and who believe
     3  they have been harmed by the negligence of a nonparticipating
     4  provider, may elect, alone or in addition to pursuing
     5  traditional tort claims against the nonparticipating providers,
     6  to submit a claim under section 704, in which instance the plan
     7  shall be subrogated to and/or credited with the beneficiary's
     8  recovery, net of reasonable attorney fees and expenses, from the
     9  nonparticipating provider to the extent of economic, noneconomic
    10  and/or failure of informed consent benefits paid to such
    11  beneficiaries.
    12                             CHAPTER 9
    14  Section 901.  Pennsylvania Health Care Trust Fund.
    15     (a)  Establishment.--The Pennsylvania Health Care Trust Fund
    16  is hereby established within the State Treasury. All moneys
    17  collected and received by the plan shall be transmitted to the
    18  State Treasurer for deposit into the fund, to be used
    19  exclusively to finance the plan.
    20     (b)  State Treasurer.--The State Treasurer may invest the
    21  principal and interest earned by the fund in any manner
    22  authorized under law for the investment of Commonwealth moneys.
    23  Any revenue or interest earned from the investments shall be
    24  credited to the fund.
    25     (c)  Administrator of finance.--The administrator of finance
    26  of the agency shall notify the board when the monthly
    27  expenditures or anticipated future expenditures of the plan
    28  appear to be in excess of the anticipated future revenues for
    29  the same period. The board shall implement appropriate measures
    30  upon such notification. Such measures shall include the
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     1  adjustment of the Wellness Tax as necessary to ensure the
     2  solvency of the trust.
     3  Section 902.  Rolling budget process.
     4     (a)  Estimated annual budget.--The board shall prepare and
     5  recommend to the General Assembly an estimated annual budget for
     6  health care, which budget specifies an estimated requirement for
     7  health care provided under this act. The budget shall include
     8  all of the following components:
     9         (1)  A system budget covering all expenditures for the
    10     agency.
    11         (2)  A capital investment budget.
    12         (3)  A purchasing budget.
    13         (4)  A research and innovation budget.
    14     (b)  Budget projections.--In preparing the budget, the board
    15  shall consider anticipated increased expenditures and savings,
    16  including, but not limited to, projected increases in
    17  expenditures due to improved access for underserved populations
    18  and improved reimbursement for primary care, projected
    19  administrative savings under the single-payer mechanism,
    20  projected savings in prescription drug expenditures under
    21  competitive bidding and a single buyer, and projected savings
    22  due to provision of primary care rather than emergency room
    23  treatment.
    24     (c)  Rolling budget.--The board shall operate on a rolling
    25  budget whereby it will anticipate its funding needs 90 days in
    26  advance and shall seek adjustments from the General Assembly to
    27  The Employer Health Services Levy and/or The Individual Wellness
    28  Tax to assure solvency of the plan and to avoid unnecessary cash
    29  surpluses in the trust.
    30  Section 903.  Limitation on administrative expense.
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     1     The system budget referred to in this chapter shall comprise
     2  the cost of the agency, services and benefits provided,
     3  administration, data gathering, planning and other activities
     4  and revenues deposited with the system account of the trust. The
     5  board shall limit administrative costs to 5% of the agency
     6  budget and shall annually evaluate methods to reduce
     7  administrative costs and publicly report the results of that
     8  evaluation.
     9  Section 904.  Funding sources.
    10     Funding of the plan shall be obtained from the following
    11  dedicated sources:
    12         (1)  Funds obtained from existing or future Federal
    13     health care programs.
    14         (2)  Funds from dedicated sources specified by the
    15     General Assembly.
    16         (3)  Receipts from the tax of 10% of gross payroll,
    17     including self-employment profits. One percent of the tax
    18     shall become effective the date that shall be the first day
    19     of a calendar month no less than 32 days after the effective
    20     date of this act, and the tax shall become fully effective
    21     November 1, 2007. Employers who are part of a collective
    22     bargaining agreement whereby the health care benefits are no
    23     less generous than those provided under the plan shall be
    24     excused from paying 90% of the tax.
    25         (4)  Receipts from the Individual Wellness Tax of 3% of
    26     personal earned, passive, pension and investment income. One-
    27     half of one percent of the Individual Wellness Tax shall
    28     become effective the date that shall be the first day of a
    29     calendar month no less than 32 days after the effective date
    30     of this act, and the IWT tax shall become fully effective
    20070H1660B2195                 - 39 -     

     1     November 1, 2007. Employees who are part of a collective
     2     bargaining agreement whereby the health care benefits are no
     3     less generous than those provided under the plan shall be
     4     excused from paying 90% of the Individual Wellness Tax.
     5         (5)  In the event the General Assembly has not responded
     6     to a request by the board for an increase in funding in
     7     anticipation of projected expenses, the board is hereby
     8     authorized to order a temporary increase, for no more than 90
     9     days, in the Employer Health Services Tax and/or the
    10     Individual Wellness Tax of no more than 250 basis points each
    11     to respond to a threatened insolvency of the plan.
    12                             CHAPTER 11
    14  Section 1101.  Transitional support and training for displaced
    15                 workers.
    16     (a)  Determination of administrator.--The administrator of
    17  transition services shall determine which citizens of this
    18  Commonwealth employed by a health care insurer, health insuring
    19  corporation or other health care-related business have lost
    20  their employment as a result of the implementation and operation
    21  of the plan. The administrator also shall determine the amount
    22  of monthly wages that the individual has lost due to the plan's
    23  implementation. The department shall attempt to position these
    24  displaced workers in comparable positions of employment or
    25  assist in the retraining and placement of such displaced
    26  employees elsewhere.
    27     (b)  Information.--The administrator of transition services
    28  shall forward the information on the amount of monthly wages
    29  lost by Commonwealth residents due to the implementation of the
    30  plan to the board. The board shall determine the amount of
    20070H1660B2195                 - 40 -     

     1  compensation required to assure income maintenance and training
     2  that each displaced worker shall receive on a case-by-case basis
     3  and shall submit a claim to the trust for payment. A displaced
     4  worker, however, shall not receive compensation or training
     5  assistance from the trust in excess of $5,000 per month for two
     6  years. Compensation paid to the displaced worker under this
     7  section shall serve as a supplement to any compensation the
     8  worker receives from any other source including unemployment
     9  insurance.
    10     (c)  Coordination of services.--The administrator of
    11  transition services shall fully coordinate activity with public
    12  and private services also available or actually participating in
    13  the assistance to the affected individuals.
    14     (d)  Appeals.--Persons dissatisfied with the level of
    15  assistance they are receiving may appeal to the office of the
    16  executive director whose determination shall be final and not
    17  subject to appeal.
    18                             CHAPTER 13
    20  Section 1301.  Preservation of volunteer emergency responder
    21                 network.
    22     Because this Commonwealth is dependent upon the volunteered
    23  services of firefighters, emergency medical technicians and
    24  search and rescue workers, the board is further charged with
    25  administering a Commonwealth income tax credit program for such
    26  volunteers.
    27  Section 1302.  Eligibility certification.
    28     Annually, in January, administrators of volunteer
    29  firefighting and rescue departments, emergency medical
    30  technicians and paramedics stations and similar volunteer
    20070H1660B2195                 - 41 -     

     1  emergency entities shall certify the identity of Commonwealth
     2  residents providing active services during the prior calendar
     3  year.
     4  Section 1303.  Eligibility criteria.
     5     Active status shall require a minimum of 200 hours of service
     6  during the preceding year and response to no less than 50% of
     7  the emergency calls during at least three of the four calendar
     8  quarters.
     9  Section 1304.  Amount of tax credit.
    10     Each volunteer certified as active shall be granted a credit
    11  equal to $1,000 toward their State income tax obligation under
    12  Article III of the act of March 4, 1971 (P.L.6, No.2), known as
    13  the Tax Reform Code of 1971. Any eligible volunteer who does not
    14  incur $1,000 in annual State income tax liability shall
    15  nevertheless be eligible for a refund equal to the amount the
    16  credit exceeds that volunteer's tax obligation.
    17  Section 1305.  Reimbursement of Department of Revenue.
    18     The State Treasury shall be reimbursed the value of such
    19  volunteer credits from the fund.
    20                             CHAPTER 15
    21                      MISCELLANEOUS PROVISIONS
    22  Section 1501.  Effective date.
    23     This act shall take effect immediately.

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