HOUSE AMENDED

 

PRIOR PRINTER'S NOS. 70, 675

PRINTER'S NO.  1006

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

SENATE BILL

 

No.

89

Session of

2009

  

  

INTRODUCED BY VANCE, FONTANA, ERICKSON, SCARNATI, PILEGGI, ALLOWAY, BAKER, BOSCOLA, BROWNE, CORMAN, COSTA, EARLL, FARNESE, FERLO, GORDNER, GREENLEAF, HUGHES, KASUNIC, LEACH, LOGAN, MELLOW, O'PAKE, ORIE, PICCOLA, PIPPY, RAFFERTY, ROBBINS, STACK, STOUT, TARTAGLIONE, WASHINGTON, WAUGH, YAW, M. WHITE AND WARD, JANUARY 29, 2009

  

  

AS REPORTED FROM COMMITTEE ON HEALTH AND HUMAN SERVICES, HOUSE OF REPRESENTATIVES, AS AMENDED, MAY 7, 2009  

  

  

  

AN ACT

  

1

Reenacting and amending the act of July 8, 1986 (P.L.408,

2

No.89), entitled, as reenacted, "An act providing for the

3

creation of the Health Care Cost Containment Council, for its

4

powers and duties, for health care cost containment through

5

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 policy declaration, for definitions, for the Health Care

9

Cost Containment Council and its powers and duties, for data

10

submission and collection and for access to council data; 

11

providing for the establishment of a Health Care Cost

12

Containment Council Act Review Committee; and further

13

providing for sunset of act.

14

The General Assembly of the Commonwealth of Pennsylvania

15

hereby enacts as follows:

16

Section 1.  The title and section 1 of the act of July 8,

17

1986 (P.L.408, No.89), known as the Health Care Cost Containment

18

Act, reenacted and amended July 17, 2003 (P.L.31, No.14), are

19

reenacted to read:

20

AN ACT

 


1

Providing for the creation of the Health Care Cost Containment

2

Council, for its powers and duties, for health care cost

3

containment through the collection and dissemination of data,

4

for public accountability of health care costs and for health

5

care for the indigent; and making an appropriation.

6

Section 1.  Short title.

7

This act shall be known and may be cited as the Health Care

8

Cost Containment Act.

9

Section 2.  Sections 2, 3, 4, 5 and 6 of the act are

10

reenacted and amended to read:

11

[Section 2.  Legislative finding and declaration.

12

The General Assembly finds that there exists in this

13

Commonwealth a major crisis because of the continuing escalation

14

of costs for health care services. Because of the continuing

15

escalation of costs, an increasingly large number of

16

Pennsylvania citizens have severely limited access to

17

appropriate and timely health care. Increasing costs are also

18

undermining the quality of health care services currently being

19

provided. Further, the continuing escalation is negatively

20

affecting the economy of this Commonwealth, is restricting new

21

economic growth and is impeding the creation of new job

22

opportunities in this Commonwealth.

23

The continuing escalation of health care costs is

24

attributable to a number of interrelated causes, including:

25

(1)  Inefficiency in the present configuration of health

26

care service systems and in their operation.

27

(2)  The present system of health care cost payments by

28

third parties.

29

(3)  The increasing burden of indigent care which

30

encourages cost shifting.

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1

(4)  The absence of a concentrated and continuous effort

2

in all segments of the health care industry to contain health

3

care costs.

4

Therefore, it is hereby declared to be the policy of the

5

Commonwealth of Pennsylvania to promote health care cost

6

containment and to identify appropriate utilization practices by

7

creating an independent council to be known as the Health Care

8

Cost Containment Council.

9

It is the purpose of this legislation to promote the public

10

interest by encouraging the development of competitive health

11

care services in which health care costs are contained and to

12

assure that all citizens have reasonable access to quality

13

health care.

14

It is further the intent of this act to facilitate the

15

continuing provision of quality, cost-effective health services

16

throughout the Commonwealth by providing current, accurate data

17

and information to the purchasers and consumers of health care

18

on both cost and quality of health care services and to public

19

officials for the purpose of determining health-related programs

20

and policies and to assure access to health care services.

21

Nothing in this act shall prohibit a purchaser from obtaining

22

from its third-party insurer, carrier or administrator, nor

23

relieve said third-party insurer, carrier or administrator from

24

the obligation of providing, on terms consistent with past

25

practices, data previously provided to a purchaser pursuant to

26

any existing or future arrangement, agreement or understanding.]

27

Section 3.  Definitions.

28

The following words and phrases when used in this act shall

29

have the meanings given to them in this section unless the

30

context clearly indicates otherwise:

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1

"Allowance."  The maximum allowed combined payment from a

2

payor and a patient to a provider for services rendered.

3

"Ambulatory service facility."  A facility licensed in this

4

Commonwealth, not part of a hospital, which provides medical,

5

diagnostic or surgical treatment to patients not requiring

6

hospitalization, including ambulatory surgical facilities,

7

ambulatory imaging or diagnostic centers, birthing centers,

8

freestanding emergency rooms and any other facilities providing

9

ambulatory care which charge a separate facility charge. This

10

term does not include the offices of private physicians or

11

dentists, whether for individual or group practices.

12

"Charge" or "rate."  The amount billed by a provider for

13

specific goods or services provided to a patient, prior to any

14

adjustment for contractual allowances.

15

"Committee."  The Health Care Cost Containment Council Act

16

Review Committee.

17

"Council."  The Health Care Cost Containment Council.

18

"Covered services."  Any health care services or procedures

19

connected with episodes of illness that require either inpatient

20

hospital care or major ambulatory service such as surgical,

21

medical or major radiological procedures, including any initial

22

and follow-up outpatient services associated with the episode of

23

illness before, during or after inpatient hospital care or major

24

ambulatory service. The term does not include routine outpatient

25

services connected with episodes of illness that do not require

26

hospitalization or major ambulatory service.

27

"Data source."  A [hospital] health care facility; ambulatory

28

service facility; physician; health maintenance organization as

29

defined in the act of December 29, 1972 (P.L.1701, No.364),

30

known as the Health Maintenance Organization Act; hospital,

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1

medical or health service plan with a certificate of authority

2

issued by the Insurance Department, including, but not limited

3

to, hospital plan corporations as defined in 40 Pa.C.S. Ch. 61 

4

(relating to hospital plan corporations) and professional health

5

services plan corporations as defined in 40 Pa.C.S. Ch. 63 

6

(relating to professional health services plan corporations);

7

commercial insurer with a certificate of authority issued by the

8

Insurance Department providing health or accident insurance;

9

self-insured employer providing health or accident coverage or

10

benefits for employees employed in the Commonwealth;

11

administrator of a self-insured or partially self-insured health

12

or accident plan providing covered services in the Commonwealth;

13

any health and welfare fund that provides health or accident

14

benefits or insurance pertaining to covered service in the

15

Commonwealth; the Department of Public Welfare for those covered

16

services it purchases or provides through the medical assistance

17

program under the act of June 13, 1967 (P.L.31, No.21), known as

18

the Public Welfare Code, and any other payor for covered

19

services in the Commonwealth other than an individual.

20

"Health care facility."  A general or special hospital,

21

including [tuberculosis and] psychiatric hospitals, kidney

<--

22

disease treatment centers, including freestanding hemodialysis

23

units, and ambulatory service facilities as defined in this

24

section, and hospices, both profit and nonprofit, and including

25

those operated by an agency of State or local government.

26

"Health care insurer."  Any person, corporation or other

27

entity that offers administrative, indemnity or payment services

28

for health care in exchange for a premium or service charge

29

under a program of health care benefits, including, but not

30

limited to, an insurance company, association or exchange

- 5 -

 


1

issuing health insurance policies in this Commonwealth; hospital

2

plan corporation as defined in 40 Pa.C.S. Ch. 61 (relating to

3

hospital plan corporations); professional health services plan

4

corporation as defined in 40 Pa.C.S. Ch. 63 (relating to

5

professional health services plan corporations); health

6

maintenance organization; preferred provider organization;

7

fraternal benefit societies; beneficial societies; and third-

8

party administrators; but excluding employers, labor unions or

9

health and welfare funds jointly or separately administered by

10

employers or labor unions that purchase or self-fund a program

11

of health care benefits for their employees or members and their

12

dependents.

13

"Health maintenance organization."  An organized system which

14

combines the delivery and financing of health care and which

15

provides basic health services to voluntarily enrolled

16

subscribers for a fixed prepaid fee, as defined in the act of

17

December 29, 1972 (P.L.1701, No.364), known as the Health

18

Maintenance Organization Act.

19

"Hospital."  An institution, licensed in this Commonwealth,

20

which is a general, [tuberculosis,] mental, chronic disease or

21

other type of hospital, or kidney disease treatment center,

22

whether profit or nonprofit, and including those operated by an

23

agency of State or local government.

24

"Indigent care."  The actual costs, as determined by the

25

council, for the provision of appropriate health care, on an

26

inpatient or outpatient basis, given to individuals who cannot

27

pay for their care because they are above the medical assistance

28

eligibility levels and have no health insurance or other

29

financial resources which can cover their health care.

30

"Major ambulatory service."  Surgical or medical procedures,

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1

including diagnostic and therapeutic radiological procedures,

2

commonly performed in hospitals or ambulatory service

3

facilities, which are not of a type commonly performed or which

4

cannot be safely performed in physicians' offices and which

5

require special facilities such as operating rooms or suites or

6

special equipment such as fluoroscopic equipment or computed

7

tomographic scanners, or a postprocedure recovery room or short-

8

term convalescent room.

9

"Medical procedure incidence variations."  The variation in

10

the incidence in the population of specific medical, surgical

11

and radiological procedures in any given year, expressed as a

12

deviation from the norm, as these terms are defined in the

13

classical statistical definition of "variation," "incidence,"

14

"deviation" and "norm."

15

"Medically indigent" or "indigent."  The status of a person

16

as described in the definition of indigent care.

17

"Payment."  The payments that providers actually accept for

18

their services, exclusive of charity care, rather than the

19

charges they bill.

20

"Payor."  Any person or entity, including, but not limited

21

to, health care insurers and purchasers, that make direct

22

payments to providers for covered services.

23

"Physician."  An individual licensed under the laws of this

24

Commonwealth to practice medicine and surgery within the scope

25

of the act of October 5, 1978 (P.L.1109, No.261), known as the

26

Osteopathic Medical Practice Act, or the act of December 20,

27

1985 (P.L.457, No.112), known as the Medical Practice Act of

28

1985.

29

"Preferred provider organization."  Any arrangement between a

30

health care insurer and providers of health care services which

- 7 -

 


1

specifies rates of payment to such providers which differ from

2

their usual and customary charges to the general public and

3

which encourage enrollees to receive health services from such

4

providers.

5

"Provider."  A hospital, an ambulatory service facility or a

6

physician.

7

"Provider quality."  The extent to which a provider renders

8

care that, within the capabilities of modern medicine, obtains

9

for patients medically acceptable health outcomes and prognoses,

10

adjusted for patient severity, and treats patients

11

compassionately and responsively.

12

"Provider service effectiveness."  The effectiveness of

13

services rendered by a provider, determined by measurement of

14

the medical outcome of patients grouped by severity receiving

15

those services.

16

"Purchaser."  All corporations, labor organizations and other

17

entities that purchase benefits which provide covered services

18

for their employees or members, either through a health care

19

insurer or by means of a self-funded program of benefits, and a

20

certified bargaining representative that represents a group or

21

groups of employees for whom employers purchase a program of

22

benefits which provide covered services, but excluding entities

23

defined in this section as "health care insurers."

24

"Raw data" or "data."  Data collected by the council under

25

section 6 [in the form initially received]. No data shall be

26

released by the council except as provided for in section 11.

27

"Severity."  In any patient, the measureable degree of the

28

potential for failure of one or more vital organs.

29

Section 4.  Health Care Cost Containment Council.

30

(a)  Establishment.--The General Assembly hereby establishes

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1

an independent council to be known as the Health Care Cost

2

Containment Council.

3

(b)  Composition.--The council shall consist of voting

4

members, composed of and appointed in accordance with the

5

following:

6

(1)  The Secretary of Health.

7

(2)  The Secretary of Public Welfare.

8

(3)  The Insurance Commissioner.

9

(4)  Six representatives of the business community, at

10

least one of whom represents small business, who are

11

purchasers of health care as defined in section 3, none of

12

which is primarily involved in the provision of health care

13

or health insurance, three of which shall be appointed by the

14

President pro tempore of the Senate and three of which shall

15

be appointed by the Speaker of the House of Representatives

16

from a list of twelve qualified persons recommended by the

17

Pennsylvania Chamber of Business and Industry. Three nominees

18

shall be representatives of small business.

19

(5)  Six representatives of organized labor, three of

20

which shall be appointed by the President pro tempore of the

21

Senate and three of which shall be appointed by the Speaker

22

of the House of Representatives from a list of twelve

23

qualified persons recommended by the Pennsylvania AFL-CIO.

24

(6)  One representative of consumers who is not primarily

25

involved in the provision of health care or health care

26

insurance, appointed by the Governor from a list of three

27

qualified persons recommended jointly by the Speaker of the

28

House of Representatives and the President pro tempore of the

29

Senate.

30

(7)  Two representatives of hospitals, appointed by the

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1

Governor from a list of five qualified hospital

2

representatives recommended by the Hospital and Health System

3

Association of Pennsylvania one of whom shall be a

4

representative of rural hospitals. Each representative under

5

this paragraph may appoint two additional delegates to act

6

for the representative only at meetings of committees, as

7

provided for in subsection (f).

8

(8)  Two representatives of physicians, appointed by the

9

Governor from a list of five qualified physician

10

representatives recommended jointly by the Pennsylvania

11

Medical Society and the Pennsylvania Osteopathic Medical

12

Society. The representative under this paragraph may appoint

13

two additional delegates to act for the representative only

14

at meetings of committees, as provided for in subsection (f).

15

(8.1)  An individual appointed by the Governor who has

16

expertise in the application of continuous quality

17

improvement methods in hospitals.

18

(8.2)  One representative of nurses, appointed by the

19

Governor from a list of three qualified representatives

20

recommended by the Pennsylvania State Nurses Association.

21

(9)  One representative of the Blue Cross and Blue Shield

22

plans in Pennsylvania, appointed by the Governor from a list

23

of three qualified persons recommended jointly by the Blue

24

Cross and Blue Shield plans of Pennsylvania.

25

(10)  One representative of commercial insurance

26

carriers, appointed by the Governor from a list of three

27

qualified persons recommended by the Insurance Federation of

28

Pennsylvania, Inc.

29

(11)  One representative of health maintenance

30

organizations, appointed by the Governor [from a list of

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1

three qualified persons recommended by the Managed Care

2

Association of Pennsylvania].

3

(12)  In the case of each appointment to be made from a

4

list supplied by a specified organization, it is incumbent

5

upon that organization to consult with and provide a list

6

which reflects the input of other equivalent organizations

7

representing similar interests. Each appointing authority

8

will have the discretion to request additions to the list

9

originally submitted. Additional names will be provided not

10

later than 15 days after such request. Appointments shall be

11

made by the appointing authority no later than 90 days after

12

receipt of the original list. If, for any reason, any

13

specified organization supplying a list should cease to

14

exist, then the respective appointing authority shall specify

15

a new equivalent organization to fulfill the responsibilities

16

of this act.

17

(c)  Chairperson and vice chairperson.--The members shall

18

annually elect, by a majority vote of the members, a chairperson

19

and a vice chairperson of the council from among the business

20

and labor representatives on the council.

21

(d)  Quorum.--Thirteen members, at least six of whom must be

22

made up of representatives of business and labor, shall

23

constitute a quorum for the transaction of any business, and the

24

act by the majority of the members present at any meeting in

25

which there is a quorum shall be deemed to be the act of the

26

council.

27

(e)  Meetings.--All meetings of the council shall be

28

advertised and conducted pursuant to 65 Pa.C.S. Ch. 7 (relating

29

to open meetings), unless otherwise provided in this section.

30

(1)  The council shall meet at least once every two

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1

months, and may provide for special meetings as it deems

2

necessary. Meeting dates shall be set by a majority vote of

3

the members of the council or by the call of the chairperson

4

upon seven days' notice to all council members.

5

(2)  All meetings of the council shall be publicly

6

advertised, as provided for in this subsection, and shall be

7

open to the public, except that the council, through its

8

bylaws, may provide for executive sessions of the council on

9

subjects permitted to be discussed in such sessions under 65

10

Pa.C.S. Ch. 7. No act of the council shall be taken in an

11

executive session.

12

(3)  The council shall publish a schedule of its meetings

13

in the Pennsylvania Bulletin and in at least one newspaper in

14

general circulation in the Commonwealth. Such notice shall be

15

published at least once in each calendar quarter and shall

16

list the schedule of meetings of the council to be held in

17

the subsequent calendar quarter. Such notice shall specify

18

the date, time and place of the meeting and shall state that

19

the council's meetings are open to the general public, except

20

that no such notice shall be required for executive sessions

21

of the council.

22

(4)  All action taken by the council shall be taken in

23

open public session, and action of the council shall not be

24

taken except upon the affirmative vote of a majority of the

25

members of the council present during meetings at which a

26

quorum is present.

27

(f)  Bylaws.--The council shall adopt bylaws, not

28

inconsistent with this act, and may appoint such committees or

29

elect such officers subordinate to those provided for in

30

subsection (c) as it deems advisable. The council shall provide

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1

for the approval and participation of additional delegates

2

appointed under subsection (b)(7) and (8) so that each

3

organization represented by delegates under those paragraphs

4

shall not have more than one vote on any committee to which they

5

are appointed. The council shall also appoint a technical

6

advisory group which shall, on an ad hoc basis, respond to

7

issues presented to it by the council or committees of the

8

council and shall make recommendations to the council. The

9

technical advisory group shall include physicians, researchers,

10

biostatisticians, one representative of the Hospital and

11

Healthsystem Association of Pennsylvania and one representative

12

of the Pennsylvania Medical Society. The Hospital and

13

Healthsystem Association of Pennsylvania and the Pennsylvania

14

Medical Society representatives shall not be subject to

15

executive committee approval. In appointing other physicians,

16

researchers and biostatisticians to the technical advisory

17

group, the council shall consult with and take nominations from

18

the representatives of the Hospital Association of Pennsylvania,

19

the Pennsylvania Medical Society, the Pennsylvania Osteopathic

20

Medical Society or other like organizations. At its discretion

21

and in accordance with this section, nominations shall be

22

approved by the executive committee of the council. If the

23

subject matter of any project exceeds the expertise of the

24

technical advisory group, physicians in appropriate specialties

25

who possess current knowledge of the issue under study may be

26

consulted. The technical advisory group shall also review the

27

availability and reliability of severity of illness measurements

28

as they relate to small hospitals and psychiatric,

29

rehabilitation and children's hospitals and shall make

30

recommendations to the council based upon this review. Meetings

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1

of the technical advisory group shall be open to the general

2

public.

3

(f.1)  Payment data advisory group.--

4

(1)  In order to assure the technical appropriateness and

5

accuracy of payment data, the council shall establish a

6

payment data advisory group to produce recommendations

7

surrounding the collection of payment data, the analysis and

8

manipulation of payment data and the public reporting of

9

payment data. The payment data advisory group shall include

10

technical experts and individuals knowledgeable in payment

11

systems and discharge claims data. The advisory group shall

12

consist of the following members appointed by the council:

13

(i)  One member representing each plan under 40

14

Pa.C.S. Ch. 61 (relating to hospital plan corporations)

15

and Ch. 63 (relating to professional health services plan

16

corporations).

17

(ii)  Two members representing commercial insurance

18

carriers.

19

(iii)  Three members representing health care

20

facilities.

21

(iv)  Three members representing physicians.

22

(2)  The payment data advisory group shall meet at least

23

four times a year and may provide for special meetings as may

24

be necessary.

25

(3)  The payment data advisory group shall review and

26

concur with the technical appropriateness of the use and

27

presentation of data and report its findings to the council

28

prior to any vote to publicly release reports. If the council

29

elects to release a report without addressing the technical

30

concerns of the advisory group, it shall prominently disclose

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1

this in the public report and include the comments of the

2

advisory group in the public report.

3

(4)  The payment data advisory group shall exercise all

4

powers necessary and appropriate to carry out its duties,

5

including advising the council on the following:

6

(i)  Collection of payment data by the council.

7

(ii)  Manipulation, adjustments and methods used with

8

payment data.

9

(iii)  Public reporting of payment data by the

10

council.

11

(g)  Compensation and expenses.--The members of the council

12

shall not receive a salary or per diem allowance for serving as

13

members of the council but shall be reimbursed for actual and

14

necessary expenses incurred in the performance of their duties.

15

Said expenses may include reimbursement of travel and living

16

expenses while engaged in council business.

17

(h)  Terms of council members.--

18

(1)  The terms of the Secretary of Health, the Secretary

19

of Public Welfare and the Insurance Commissioner shall be

20

concurrent with their holding of public office. The council

21

members under subsection (b)(4) through (11) shall each serve

22

for a term of four years and shall continue to serve

23

thereafter until their successor is appointed.

24

(2)  Vacancies on the council shall be filled in the

25

manner designated under subsection (b), within 60 days of the

26

vacancy, except that when vacancies occur among the

27

representatives of business or organized labor, two

28

nominations shall be submitted by the organization specified

29

in subsection (b) for each vacancy on the council. If the

30

officer required in subsection (b) to make appointments to

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1

the council fails to act within 60 days of the vacancy, the

2

council chairperson may appoint one of the persons

3

recommended for the vacancy until the appointing authority

4

makes the appointment.

5

(3)  A member may be removed for just cause by the

6

appointing authority after recommendation by a vote of at

7

least 14 members of the council.

8

(4)  No appointed member under subsection (b)(4) through

9

(11) shall be eligible to serve more than two full

10

consecutive terms of four years beginning on the effective

11

date of this paragraph.

12

(j)  Subsequent appointments.--Submission of lists of

13

recommended persons and appointments of council members for

14

succeeding terms shall be made in the same manner as prescribed

15

in subsection (b), except that:

16

(1)  Organizations required under subsection (b) to

17

submit lists of recommended persons shall do so at least 60

18

days prior to expiration of the council members' terms.

19

(2)  The officer required under subsection (b) to make

20

appointments to the council shall make said appointments at

21

least 30 days prior to expiration of the council members'

22

terms. If the appointments are not made within the specified

23

time, the council chairperson may make interim appointments

24

from the lists of recommended individuals. An interim

25

appointment shall be valid only until the appropriate officer

26

under subsection (b) makes the required appointment. Whether

27

the appointment is by the required officer or by the

28

chairperson of the council, the appointment shall become

29

effective immediately upon expiration of the incumbent

30

member's term.

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1

Section 5.  Powers and duties of the council.

2

(a)  General powers.--The council shall exercise all powers

3

necessary and appropriate to carry out its duties, including the

4

following:

5

(1)  To employ an executive director, investigators and

6

other staff necessary to comply with the provisions of this

7

act and regulations promulgated thereunder, to employ or

8

retain legal counsel and to engage professional consultants,

9

as it deems necessary to the performance of its duties. Any

10

consultants, other than sole source consultants, engaged by

11

the council shall be selected in accordance with the

12

provisions for contracting with vendors set forth in section

13

16.

14

(2)  To fix the compensation of all employees and to

15

prescribe their duties. Notwithstanding the independence of

16

the council under section 4(a), employees under this

17

paragraph shall be deemed employees of the Commonwealth for

18

the purposes of participation in the Pennsylvania Employee

19

Benefit Trust Fund.

20

(3)  To make and execute contracts and other instruments,

21

including those for purchase of services and purchase or

22

leasing of equipment and supplies, necessary or convenient to

23

the exercise of the powers of the council. Any such contract

24

shall be let only in accordance with the provision for

25

contracting with vendors set forth in section 16.

26

(4)  To conduct examinations and investigations, to

27

conduct audits, pursuant to the provisions of subsection (c),

28

and to hear testimony and take proof, under oath or

29

affirmation, at public or private hearings, on any matter

30

necessary to its duties.

- 17 -

 


1

(4.1)  To provide hospitals with individualized data on

2

patient safety indicators pursuant to section 6(c)(7). The

3

data shall be risk adjusted and made available to hospitals

4

electronically and free of charge on a quarterly basis within

5

45 days of receipt of the corrected quarterly data from the

6

hospitals. The data is intended to provide the patient safety

7

committee of each hospital with information necessary to

8

assist in conducting patient safety analysis.

9

(5)  To do all things necessary to carry out its duties

10

under the provisions of this act.

11

(b)  Rules and regulations.--The council shall promulgate

12

rules and regulations in accordance with the act of June 25,

13

1982 (P.L.633, No.181), known as the Regulatory Review Act,

14

necessary to carry out its duties under this act. This

15

subsection shall not apply to regulations in effect on June 30,

16

[2003] 2008.

<--

17

(c)  Audit powers.--The council shall have the right to

18

independently audit all information required to be submitted by

19

data sources as needed to corroborate the accuracy of the

20

submitted data, pursuant to the following:

21

(1)  Audits of information submitted by providers or

22

health care insurers shall be performed on a sample and

23

issue-specific basis, as needed by the council, and shall be

24

coordinated, to the extent practicable, with audits performed

25

by the Commonwealth. All health care insurers and providers

26

are hereby required to make those books, records of accounts

27

and any other data needed by the auditors available to the

28

council at a convenient location within 30 days of a written

29

notification by the council.

30

(2)  Audits of information submitted by purchasers shall

- 18 -

 


1

be performed on a sample basis, unless there exists

2

reasonable cause to audit specific purchasers, but in no case

3

shall the council have the power to audit financial

4

statements of purchasers.

5

(3)  All audits performed by the council shall be

6

performed at the expense of the council.

7

(4)  The results of audits of providers or health care

8

insurers shall be provided to the audited providers and

9

health care insurers on a timely basis, not to exceed 30 days

10

beyond presentation of audit findings to the council.

11

(d)  General duties and functions.--The council is hereby

12

authorized to and shall perform the following duties and

13

functions:

14

(1)  Develop a computerized system for the collection,

15

analysis and dissemination of data. The council may contract

16

with a vendor who will provide such data processing services.

17

The council shall assure that the system will be capable of

18

processing all data required to be collected under this act.

19

Any vendor selected by the council shall be selected in

20

accordance with the provisions of section 16, and said vendor

21

shall relinquish any and all proprietary rights or claims to

22

the data base created as a result of implementation of the

23

data processing system.

24

(2)  Establish a Pennsylvania Uniform Claims and Billing

25

Form for all data sources and all providers which shall be

26

utilized and maintained by all data sources and all providers

27

for all services covered under this act.

28

(3)  Collect and disseminate data, as specified in

29

section 6, and other information from data sources to which

30

the council is entitled, prepared according to formats, time

- 19 -

 


1

frames and confidentiality provisions as specified in

2

sections 6 and 10, and by the council.

3

(4)  Adopt and implement a methodology to collect and

4

disseminate data reflecting provider quality and provider

5

service effectiveness pursuant to section 6.

6

(5)  Subject to the restrictions on access to raw data

7

set forth in section 10, issue special reports and make

8

available raw data as defined in section 3 to any purchaser

9

requesting it. Sale by any recipient or exchange or

10

publication by a recipient, other than a purchaser, of raw

11

council data to other parties without the express written

12

consent of, and under terms approved by, the council shall be

13

unauthorized use of data pursuant to section 10(c).

14

(6)  On an annual basis, publish in the Pennsylvania

15

Bulletin a list of all the raw data reports it has prepared

16

under section 10(f) and a description of the data obtained

17

through each computer-to-computer access it has provided

18

under section 10(f) and of the names of the parties to whom

19

the council provided the reports or the computer-to-computer

20

access during the previous month.

21

(7)  Promote competition in the health care and health

22

insurance markets.

23

(8)  Assure that the use of council data does not raise

24

access barriers to care.

25

(10)  Make annual reports to the General Assembly on the

26

rate of increase in the cost of health care in the

27

Commonwealth and the effectiveness of the council in carrying

28

out the legislative intent of this act. In addition, the

29

council may make recommendations on the need for further

30

health care cost containment legislation. The council shall

- 20 -

 


1

also make annual reports to the General Assembly on the

2

quality and effectiveness of health care and access to health

3

care for all citizens of the Commonwealth.

4

(12)  Conduct studies and publish reports thereon

5

analyzing the effects that noninpatient, alternative health

6

care delivery systems have on health care costs. These

7

systems shall include, but not be limited to: HMO's; PPO's;

8

primary health care facilities; home health care; attendant

9

care; ambulatory service facilities; freestanding emergency

10

centers; birthing centers; and hospice care. These reports

11

shall be submitted to the General Assembly and shall be made

12

available to the public.

13

(13)  Conduct studies and make reports concerning the

14

utilization of experimental and nonexperimental transplant

15

surgery and other highly technical and experimental

16

procedures, including costs and mortality rates.

17

[(14)  In order to ensure that the council adopts and

18

maintains both scientifically credible and cost-effective

19

methodology to collect and disseminate data reflecting

20

provider quality and effectiveness, the council shall, within

21

one year of the effective date of this paragraph, utilizing

22

current Commonwealth agency guidelines and procedures, issue

23

a request for information from any vendor that wishes to

24

provide data collection or risk adjustment methodology to the

25

council to help meet the requirements of this subsection and

26

section 6. The council shall establish an independent Request

27

for Information Review Committee to review and rank all

28

responses and to make a final recommendation to the council.

29

The Request for Information Review Committee shall consist of

30

the following members appointed by the Governor:

- 21 -

 


1

(i)  One representative of the Hospital and

2

Healthsystem Association of Pennsylvania.

3

(ii)  One representative of the Pennsylvania Medical

4

Society.

5

(iii)  One representative of insurance.

6

(iv)  One representative of labor.

7

(v)  One representative of business.

8

(vi)  Two representatives of the general public.

9

(15)  The council shall execute a request for proposals

10

with third-party vendors for the purpose of demonstrating a

11

methodology for the collection, analysis and reporting of

12

hospital-specific complication rates. The results of this

13

demonstration shall be provided to the chairman and minority

14

chairman of the Public Health and Welfare Committee of the

15

Senate and the chairman and minority chairman of the Health

16

and Human Services Committee of the House of Representatives.

17

This methodology may be utilized by the council for public

18

reporting on comparative hospital complication rates.]

19

Section 6.  Data submission and collection.

20

(a)  (1)  Submission of data.--The council is hereby

21

authorized to collect and data sources are hereby required to

22

submit, upon request of the council, all data required in

23

this section, according to uniform submission formats, coding

24

systems and other technical specifications necessary to

25

render the incoming data substantially valid, consistent,

26

compatible and manageable using electronic data processing

27

according to data submission schedules, such schedules to

28

avoid, to the extent possible, submission of identical data

29

from more than one data source, established and promulgated

30

by the council in regulations pursuant to its authority under

- 22 -

 


1

section 5(b). If payor data is requested by the council, it

2

shall, to the extent possible, be obtained from primary payor

3

sources. The council shall not require any data sources to

4

contract with any specific vendor for submission of any

5

specific data elements to the council.

6

(1.1)  Any data source shall comply with data submission

7

guidelines established in the report submitted under section

8

17.2. The council shall maintain a vendor list of at least

9

two vendors that may be chosen by any data source for

10

submission of any specific data elements.

11

(2)  Except as provided in this section, the council may

12

adopt any nationally recognized methodology to adjust data

13

submitted under subsection (c) for severity of illness. Every

14

three years after the effective date of this paragraph, the

15

council shall solicit bids from third-party vendors to adjust

16

the data. The solicitation shall be in accordance with 62

17

Pa.C.S. (relating to procurement). [Except as provided in

18

subparagraph (i), in] In carrying out its responsibilities,

19

the council shall not require health care facilities to

20

report data elements which are not included in the manual

21

developed by the national uniform billing committee. The

22

[following apply:

<--

23

(i)  Within 60 days of the effective date of this

24

paragraph, the] council shall publish in the Pennsylvania

<--

25

Bulletin a list of diseases, procedures and medical

26

conditions, not to exceed 35, for which data under

27

subsections (c)(21) and (d) shall be required. The chosen

28

list shall not represent more than 50% of total hospital

29

discharges, based upon the previous year's hospital

30

discharge data. Subsequent to the publication of the

- 23 -

 


1

list, any data submission requirements under subsections

2

(c)(21) and (d) previously in effect shall be null and

3

void for diseases, procedures and medical conditions not

4

found on the list. All other data elements pursuant to

5

subsection (c) shall continue to be required from data

6

sources. The council shall review the list and may add no

7

more than a net of three diseases, procedures or medical

8

conditions per year over a five-year period starting on

9

the effective date of this [subparagraph] paragraph. The

<--

10

adjusted list of diseases, procedures and medical

11

conditions shall at no time be more than 50% of total

12

hospital discharges.

13

[(ii)  If the current data vendor is unable to

14

achieve, on a per-chart basis, savings of at least 40% in

15

the cost of hospital compliance with the data abstracting

16

and submission requirements of this act by June 30, 2004,

17

as compared to June 30, 2003, then the council shall

18

disqualify the current vendor and reopen the bidding

19

process. The independent auditor shall determine the

20

extent and validity of the savings. In determining any

21

demonstrated cost savings, surveys of all hospitals in

22

this Commonwealth shall be conducted and consideration

23

shall be given at a minimum to:

24

(A)  new costs, in terms of making the

25

methodology operational, associated with laboratory,

26

pharmacy and other information systems a hospital is

27

required to purchase in order to reduce hospital

28

compliance costs, including the cost of electronic

29

transfer of required data; and

30

(B)  the audited direct personnel and related

- 24 -

 


1

costs of data abstracting and submission required.

2

(iii)  Review by the independent auditor shall

3

commence by March 1, 2004, and shall conclude with a

4

report of findings by July 31, 2004. The report shall be

5

delivered to the council, the Governor, the Health and

6

Human Services Committee of the House of Representatives

7

and the Public Health and Welfare Committee of the

8

Senate.

9

(a.1)  Abstraction and technology work group.--

10

(1)  The council shall establish a data abstraction and

11

technology work group to produce recommendations for

12

improving and refining the data required by the council and

13

reducing, through innovative direct data collection

14

techniques, the cost of collecting required data. The work

15

group shall consist of the following members appointed by the

16

council:

17

(i)  one member representing the Office of Health

18

Care Reform;

19

(ii)  one member representing the business community;

20

(iii)  one member representing labor;

21

(iv)  one member representing consumers;

22

(v)  two members representing physicians;

23

(vi)  two members representing nurses;

24

(vii)  two members representing hospitals;

25

(viii)  one member representing health underwriters;

26

and

27

(ix)  one member representing commercial insurance

28

carriers.

29

(2)  The work group, with approval of the council, may

30

hire an independent auditor to determine the value of various

- 25 -

 


1

data sets. The work group shall have no more than one year to

2

study current data requirements and methods of collecting and

3

transferring data and to make recommendations for changes to

4

produce a 50% overall reduction in the cost of collecting and

5

reporting required data to the council while maintaining the

6

scientific credibility of the council's analysis and

7

reporting. The work group recommendations shall be presented

8

to the council for a vote.]

9

(b)  Pennsylvania Uniform Claims and Billing Form.--The

10

council shall [adopt, within 180 days of the commencement of its

11

operations pursuant to section 4(i),] maintain a Pennsylvania

12

Uniform Claims and Billing Form format. The council shall

13

furnish said claims and billing form format to all data sources,

14

and said claims and billing form shall be utilized and

15

maintained by all data sources for all services covered by this

16

act. The Pennsylvania Uniform Claims and Billing Form shall

17

consist of the Uniform Hospital Billing Form [UB-82/HCFA-1450,

18

and the HCFA-1500, or their successors], as developed by the

19

National Uniform Billing Committee, with additional fields as

20

necessary to provide all of the data set forth in subsections

21

(c) and (d).

22

(c)  Data elements.--For each covered service performed in

23

Pennsylvania, the council shall be required to collect the

24

following data elements:

25

(1)  uniform patient identifier, continuous across

26

multiple episodes and providers;

27

(2)  patient date of birth;

28

(3)  patient sex;

29

(3.1)  patient race, consistent with the method of

30

collection of race/ethnicity data by the United States Bureau

- 26 -

 


1

of the Census and the United States Standard Certificates of

2

Live Birth and Death;

3

(4)  patient ZIP Code number;

4

(5)  date of admission;

5

(6)  date of discharge;

6

(7)  principal and secondary diagnoses by standard code,

7

including external cause of injury, complication, infection

8

and childbirth;

9

(8)  principal procedure by council-specified standard

10

code and date;

11

(9)  up to three secondary procedures by council-

12

specified standard codes and dates;

13

(10)  uniform health care facility identifier, continuous

14

across episodes, patients and providers;

15

(11)  uniform identifier of admitting physician, by

16

unique physician identification number established by the

17

council, continuous across episodes, patients and providers;

18

(12)  uniform identifier of consulting physicians, by

19

unique physician identification number established by the

20

council, continuous across episodes, patients and providers;

21

(13)  total charges of health care facility, segregated

22

into major categories, including, but not limited to, room

23

and board, radiology, laboratory, operating room, drugs,

24

medical supplies and other goods and services according to

25

guidelines specified by the council;

26

(14)  actual payments to health care facility,

27

segregated, if available, according to the categories

28

specified in paragraph (13);

29

(15)  charges of each physician or professional rendering

30

service relating to an incident of hospitalization or

- 27 -

 


1

treatment in an ambulatory service facility;

2

(16)  actual payments to each physician or professional

3

rendering service pursuant to paragraph (15);

4

(17)  uniform identifier of primary payor;

5

(18)  ZIP Code number of facility where health care

6

service is rendered;

7

(19)  uniform identifier for payor group contract number;

8

(20)  patient discharge status; and

9

(21)  provider service effectiveness and provider quality

10

pursuant to section 5(d)(4) and subsection (d).

11

(d)  Provider quality and provider service effectiveness data

12

elements.--In carrying out its duty to collect data on provider

13

quality and provider service effectiveness under section 5(d)(4)

14

and subsection (c)(21), the council shall define a methodology

15

to measure provider service effectiveness which may include

16

additional data elements to be specified by the council

17

sufficient to carry out its responsibilities under section 5(d)

18

(4). The [council may adopt a nationally recognized methodology

19

of quantifying and collecting data on provider quality and

20

provider service effectiveness until such time as the council

21

has the capability of developing its own methodology and

22

standard data elements. The council shall include in the

23

Pennsylvania Uniform Claims and Billing Form a field consisting

24

of the data elements required pursuant to subsection (c)(21) to

25

provide information on each provision of covered services

26

sufficient to permit analysis of provider quality and provider

27

service effectiveness within 180 days of commencement of its

28

operations pursuant to section 4. In carrying out its

29

responsibilities, the] council shall not require health care

30

insurers to report on data elements that are not reported to

- 28 -

 


1

nationally recognized accrediting organizations, to the

2

Department of Health or to the Insurance Department in quarterly

3

or annual reports. The council shall not require reporting by

4

health care insurers in different formats than are required for

5

reporting to nationally recognized accrediting organizations or

6

on quarterly or annual reports submitted to the Department of

7

Health or to the Insurance Department. The council may adopt the

8

quality findings as reported to nationally recognized

9

accrediting organizations. Additional quality data elements must

10

be defined and released for public comment prior to the

11

promulgation of regulations under section 5(b). The public

12

comment period shall be no less than 30 days from the release of

13

these elements.

14

(e)  Reserve field utilization and addition or deletion of

15

data elements.--The council shall include in the Pennsylvania

16

Uniform Claims and Billing Form a reserve field. The council may

17

utilize the reserve field by adding other data elements beyond

18

those required to carry out its responsibilities under section

19

5(d)(3) and (4) and subsections (c) and (d), or the council may

20

delete data elements from the Pennsylvania Uniform Claims and

21

Billing Form only by a majority vote of the council and only

22

pursuant to the following procedure:

23

(1)  The council shall obtain a cost-benefit analysis of

24

the proposed addition or deletion which shall include the

25

cost to data sources of any proposed additions.

26

(2)  The council shall publish notice of the proposed

27

addition or deletion, along with a copy or summary of the

28

cost-benefit analysis, in the Pennsylvania Bulletin, and such

29

notice shall include provision for a 60-day comment period.

30

(3)  The council may hold additional hearings or request

- 29 -

 


1

such other reports as it deems necessary and shall consider

2

the comments received during the 60-day comment period and

3

any additional information gained through such hearings or

4

other reports in making a final determination on the proposed

5

addition or deletion.

6

(f)  Other data required to be submitted.--Providers are

7

hereby required to submit and the council is hereby authorized

8

to collect, in accordance with submission dates and schedules

9

established by the council, the following additional data,

10

provided such data is not available to the council from public

11

records:

12

(1)  Audited annual financial reports of all hospitals

13

and ambulatory service facilities providing covered services

14

as defined in section 3.

15

(2)  The Medicare cost report [(OMB Form 2552 or

16

equivalent Federal form), or the AG-12 form] for Medical

17

Assistance or successor forms, [whether completed or

18

partially completed, and] including the settled Medicare cost

19

report [and the certified AG-12 form].

20

(3)  Additional data, including, but not limited to, data

21

which can be used [to provide at least the following

22

information] in reports about:

23

(i)  the incidence of medical and surgical procedures

24

in the population for individual providers;

25

(ii)  physicians who provide covered services and

26

accept medical assistance patients;

27

(iii)  physicians who provide covered services and

28

accept Medicare assignment as full payment;

29

(v)  mortality rates for specified diagnoses and

30

treatments, grouped by severity, for individual

- 30 -

 


1

providers;

2

(vi)  rates of infection for specified diagnoses and

3

treatments, grouped by severity, for individual

4

providers;

5

(vii)  morbidity rates for specified diagnoses and

6

treatments, grouped by severity, for individual

7

providers;

8

(viii)  readmission rates for specified diagnoses and

9

treatments, grouped by severity, for individual

10

providers; [and]

11

(ix)  rate of incidence of postdischarge professional

12

care for selected diagnoses and procedures, grouped by

13

severity, for individual providers; and

14

(x)  data from other public sources.

15

(4)  Any other data the council requires to carry out its

16

responsibilities pursuant to section 5(d).

17

(f.1)  Review and correction of data.--The council shall

18

provide a reasonable period for data sources to review and

19

correct the data submitted under section 6 which the council

20

intends to prepare and issue in reports to the General Assembly,

21

to the general public or in special studies and reports under

22

section 11. When corrections are provided, the council shall

23

correct the appropriate data in its data files and subsequent

24

reports.

25

(g)  Allowance for clarification or dissents.--The council

26

shall maintain a file of written statements submitted by data

27

sources who wish to provide an explanation of data that they

28

feel might be misleading or misinterpreted. The council shall

29

provide access to such file to any person and shall, where

30

practical, in its reports and data files indicate the

- 31 -

 


1

availability of such statements. When the council agrees with

2

such statements, it shall correct the appropriate data and

3

comments in its data files and subsequent reports.

4

(g.1)  Allowance for correction.--The council shall verify

5

the patient safety indicator data submitted by hospitals

6

pursuant to subsection (c)(7) within 60 days of receipt. The

7

council may allow hospitals to make changes to the data

8

submitted during the verification period. After the verification

9

period, but within 45 days of receipt of the adjusted hospital

10

data, the council shall risk adjust the information and provide

11

reports to the patient safety committee of the relevant

12

hospital.

13

(h)  Availability of data.--Nothing in this act shall

14

prohibit a purchaser from obtaining from its health care

15

insurer, nor relieve said health care insurer from the

16

obligation of providing said purchaser, on terms consistent with

17

past practices, data previously provided or additional data not

18

currently provided to said purchaser by said health care insurer

19

pursuant to any existing or future arrangement, agreement or

20

understanding.

21

Section 3.  Sections 7, 8 and 9 of the act are reenacted to

22

read:

23

Section 7.  Data dissemination and publication.

24

(a)  Public reports.--Subject to the restrictions on access

25

to council data set forth in section 10 and utilizing the data

26

collected under section 6 as well as other data, records and

27

matters of record available to it, the council shall prepare and

28

issue reports to the General Assembly and to the general public

29

according to the following provisions:

30

(1)  The council shall, for every provider of both

- 32 -

 


1

inpatient and outpatient services within this Commonwealth

2

and within appropriate regions and subregions, prepare and

3

issue reports on provider quality and service effectiveness

4

on diseases or procedures that, when ranked by volume, cost,

5

payment and high variation in outcome, represent the best

6

opportunity to improve overall provider quality, improve

7

patient safety and provide opportunities for cost reduction.

8

These reports shall provide comparative information on the

9

following:

10

(i)  Differences in mortality rates; differences in

11

length of stay; differences in complication rates;

12

differences in readmission rates; differences in

13

infection rates; and other comparative outcome measures

14

the council may develop that will allow purchasers,

15

providers and consumers to make purchasing and quality

16

improvement decisions based upon quality patient care and

17

to restrain costs.

18

(ii)  The incidence rate of selected medical or

19

surgical procedures, the quality and service

20

effectiveness and the payments received for those

21

providers, identified by the name and type or specialty,

22

for which these elements vary significantly from the

23

norms for all providers.

24

(2)  In preparing its reports under paragraph (1), the

25

council shall ensure that factors which have the effect of

26

either reducing provider revenue or increasing provider costs

27

and other factors beyond a provider's control which reduce

28

provider competitiveness in the marketplace are explained in

29

the reports. The council shall also ensure that any

30

clarifications and dissents submitted by individual providers

- 33 -

 


1

under section 6(g) are noted in any reports that include

2

release of data on that individual provider.

3

(b)  Raw data reports and computer access to council data.--

4

The council shall provide special reports derived from raw data

5

and a means for computer-to-computer access to its raw data to

6

any purchaser, pursuant to section 10(f). The council shall

7

provide such reports and computer-to-computer access, at its

8

discretion, to other parties, pursuant to section 10(g). The

9

council shall provide these special reports and computer-to-

10

computer access in as timely a fashion as the council's

11

responsibilities to publish the public reports required in this

12

section will allow. Any such provision of special reports or

13

computer-to-computer access by the council shall be made only

14

subject to the restrictions on access to raw data set forth in

15

section 10(b) and only after payment for costs of preparation or

16

duplication pursuant to section 10(f) or (g).

17

Section 8.  Health care for the medically indigent.

18

(a)  Declaration of policy.--The General Assembly finds that

19

every person in this Commonwealth should receive timely and

20

appropriate health care services from any provider operating in

21

this Commonwealth; that, as a continuing condition of licensure,

22

each provider should offer and provide medically necessary,

23

lifesaving and emergency health care services to every person in

24

this Commonwealth, regardless of financial status or ability to

25

pay; and that health care facilities may transfer patients only

26

in instances where the facility lacks the staff or facilities to

27

properly render definitive treatment.

28

(b)  Studies on indigent care.--To reduce the undue burden on

29

the several providers that disproportionately treat medically

30

indigent people on an uncompensated basis, to contain the long-

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1

term costs generated by untreated or delayed treatment of

2

illness and disease and to determine the most appropriate means

3

of treating and financing the treatment of medically indigent

4

persons, the council, at the request of the Governor or the

5

General Assembly, may undertake studies and utilize its current

6

data base to:

7

(1)  Study and analyze the medically indigent population,

8

the magnitude of uncompensated care for the medically

9

indigent, the degree of access to and the result of any lack

10

of access by the medically indigent to appropriate care, the

11

types of providers and the settings in which they provide

12

indigent care and the cost of the provision of that care

13

pursuant to subsection (c).

14

(2)  Determine, from studies undertaken under paragraph

15

(1), a definition of the medically indigent population and

16

the most appropriate method for the delivery of timely and

17

appropriate health care services to the medically indigent.

18

(c)  Studies.--The council shall conduct studies pursuant to

19

subsection (b)(1) and thereafter report to the Governor and the

20

General Assembly the results of the studies and its

21

recommendations. The council may contract with an independent

22

vendor to conduct the study in accordance with the provisions

23

for selecting vendors in section 16. The study shall include,

24

but not be limited to, the following:

25

(1)  the number and characteristics of the medically

26

indigent population, including such factors as income,

27

employment status, health status, patterns of health care

28

utilization, type of health care needed and utilized,

29

eligibility for health care insurance, distribution of this

30

population on a geographic basis and by age, sex and racial

- 35 -

 


1

or linguistic characteristics, and the changes in these

2

characteristics, including the following:

3

(i)  the needs and problems of indigent persons in

4

urban areas;

5

(ii)  the needs and problems of indigent persons in

6

rural areas;

7

(iii)  the needs and problems of indigent persons who

8

are members of racial or linguistic minorities;

9

(iv)  the needs and problems of indigent persons in

10

areas of high unemployment; and

11

(v)  the needs and problems of the underinsured;

12

(2)  the degree of and any change in access of this

13

population to sources of health care, including hospitals,

14

physicians and other providers;

15

(3)  the distribution and means of financing indigent

16

care between and among providers, insurers, government,

17

purchasers and consumers, and the effect of that distribution

18

on each;

19

(4)  the major types of care rendered to the indigent,

20

the setting in which each type of care is rendered and the

21

need for additional care of each type by the indigent;

22

(5)  the likely impact of changes in the health delivery

23

system, including managed care entities, and the effects of

24

cost containment in the Commonwealth on the access to,

25

availability of and financing of needed care for the

26

indigent, including the impact on providers which provide a

27

disproportionate amount of care to the indigent;

28

(6)  the distribution of delivered care and actual cost

29

to render such care by provider, region and subregion;

30

(7)  the provision of care to the indigent through

- 36 -

 


1

improvements in the primary health care system, including the

2

management of needed hospital care by primary care providers;

3

(8)  innovative means to finance and deliver care to the

4

medically indigent; and

5

(9)  reduction in the dependence of indigent persons on

6

hospital services through improvements in preventive health

7

measures.

8

Section 9.  Mandated health benefits.

9

In relation to current law or proposed legislation, the

10

council shall, upon the request of the appropriate committee

11

chairman in the Senate and in the House of Representatives or

12

upon the request of the Secretary of Health, provide information

13

on the proposed mandated health benefit pursuant to the

14

following:

15

(1)  The General Assembly hereby declares that proposals

16

for mandated health benefits or mandated health insurance

17

coverage should be accompanied by adequate, independently

18

certified documentation defining the social and financial

19

impact and medical efficacy of the proposal. To that end the

20

council, upon receipt of such requests, is hereby authorized

21

to conduct a preliminary review of the material submitted by

22

both proponents and opponents concerning the proposed

23

mandated benefit. If, after this preliminary review, the

24

council is satisfied that both proponents and opponents have

25

submitted sufficient documentation necessary for a review

26

pursuant to paragraphs (3) and (4), the council is directed

27

to contract with individuals, pursuant to the selection

28

procedures for vendors set forth in section 16, who will

29

constitute a Mandated Benefits Review Panel to review

30

mandated benefits proposals and provide independently

- 37 -

 


1

certified documentation, as provided for in this section.

2

(2)  The panel shall consist of senior researchers, each

3

of whom shall be a recognized expert:

4

(i)  one in health research;

5

(ii)  one in biostatistics;

6

(iii)  one in economic research;

7

(iv)  one, a physician, in the appropriate specialty

8

with current knowledge of the subject being proposed as a

9

mandated benefit; and

10

(v)  one with experience in insurance or actuarial

11

research.

12

(3)  The Mandated Benefits Review Panel shall have the

13

following duties and responsibilities:

14

(i)  To review documentation submitted by persons

15

proposing or opposing mandated benefits within 90 days of

16

submission of said documentation to the panel.

17

(ii)  To report to the council, pursuant to its

18

review in subparagraph (i), the following:

19

(A)  Whether or not the documentation is complete

20

as defined in paragraph (4).

21

(B)  Whether or not the research cited in the

22

documentation meets professional standards.

23

(C)  Whether or not all relevant research

24

respecting the proposed mandated benefit has been

25

cited in the documentation.

26

(D)  Whether or not the conclusions and

27

interpretations in the documentation are consistent

28

with the data submitted.

29

(4)  To provide the Mandated Benefits Review Panel with

30

sufficient information to carry out its duties and

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1

responsibilities pursuant to paragraph (3), persons proposing

2

or opposing legislation mandating benefits coverage should

3

submit documentation to the council, pursuant to the

4

procedure established in paragraph (5), which demonstrates

5

the following:

6

(i)  The extent to which the proposed benefit and the

7

services it would provide are needed by, available to and

8

utilized by the population of the Commonwealth.

9

(ii)  The extent to which insurance coverage for the

10

proposed benefit already exists, or if no such coverage

11

exists, the extent to which this lack of coverage results

12

in inadequate health care or financial hardship for the

13

population of the Commonwealth.

14

(iii)  The demand for the proposed benefit from the

15

public and the source and extent of opposition to

16

mandating the benefit.

17

(iv)  All relevant findings bearing on the social

18

impact of the lack of the proposed benefit.

19

(v)  Where the proposed benefit would mandate

20

coverage of a particular therapy, the results of at least

21

one professionally accepted, controlled trial comparing

22

the medical consequences of the proposed therapy,

23

alternative therapies and no therapy.

24

(vi)  Where the proposed benefit would mandate

25

coverage of an additional class of practitioners, the

26

results of at least one professionally accepted,

27

controlled trial comparing the medical results achieved

28

by the additional class of practitioners and those

29

practitioners already covered by benefits.

30

(vii)  The results of any other relevant research.

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1

(viii)  Evidence of the financial impact of the

2

proposed legislation, including at least:

3

(A)  The extent to which the proposed benefit

4

would increase or decrease cost for treatment or

5

service.

6

(B)  The extent to which similar mandated

7

benefits in other states have affected charges, costs

8

and payments for services.

9

(C)  The extent to which the proposed benefit

10

would increase the appropriate use of the treatment

11

or service.

12

(D)  The impact of the proposed benefit on

13

administrative expenses of health care insurers.

14

(E)  The impact of the proposed benefits on

15

benefits costs of purchasers.

16

(F)  The impact of the proposed benefits on the

17

total cost of health care within the Commonwealth.

18

(5)  The procedure for review of documentation is as

19

follows:

20

(i)  Any person wishing to submit information on

21

proposed legislation mandating insurance benefits for

22

review by the panel should submit the documentation

23

specified in paragraph (4) to the council.

24

(ii)  The council shall, within 30 days of receipt of

25

the documentation:

26

(A)  Publish in the Pennsylvania Bulletin notice

27

of receipt of the documentation, a description of the

28

proposed legislation, provision for a period of 60

29

days for public comment and the time and place at

30

which any person may examine the documentation.

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1

(B)  Submit copies of the documentation to the

2

Secretary of Health and the Insurance Commissioner,

3

who shall review and submit comments to the council

4

on the proposed legislation within 30 days.

5

(C)  Submit copies of the documentation to the

6

panel, which shall review the documentation and issue

7

their findings, pursuant to paragraph (3), within 90

8

days.

9

(iii)  Upon receipt of the comments of the Secretary

10

of Health and the Insurance Commissioner and of the

11

findings of the panel, pursuant to subparagraph (ii), but

12

no later than 120 days following the publication required

13

in subparagraph (ii), the council shall submit said

14

comments and findings, together with its recommendations

15

respecting the proposed legislation, to the Governor, the

16

President pro tempore of the Senate, the Speaker of the

17

House of Representatives, the Secretary of Health, the

18

Insurance Commissioner and the person who submitted the

19

information pursuant to subparagraph (i).

20

Section 4.  Section 10 of the act is reenacted and amended to

21

read:

22

Section 10.  [Access] Right-to-Know Law and access to council

23

data.

24

(a)  Public access.--The information and data received by the

25

council shall be utilized by the council for the benefit of the

26

public and public officials. Subject to the specific limitations

27

set forth in this section and section 3101.1 of the act of

28

February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law,

29

the council shall make determinations on requests for

30

information in favor of access. Payor discounts and allowances

- 41 -

 


1

are considered confidential proprietary information and, as such

2

are not records subject to the requirements for public access

3

established under the Right-to-Know Law.

4

(a.1)  Outreach programs.--The council shall develop and

5

implement outreach programs designed to make its information

6

understandable and usable to purchasers, providers, other

7

Commonwealth agencies and the general public. The programs shall

8

include efforts to educate through pamphlets, booklets, seminars

9

and other appropriate measures and to facilitate making more

10

informed health care choices.

11

(b)  Limitations on access.--Unless specifically provided for

12

in this act, neither the council nor any contracting system

13

vendor shall release and no data source, person, member of the

14

public or other user of any data of the council shall gain

15

access to:

16

(1)  Any raw data of the council that does not

17

simultaneously disclose payment, as well as provider quality

18

and provider service effectiveness pursuant to sections 5(d)

19

(4) and 6(d) or 7(a)(1)(iii).

20

(2)  Any raw data of the council which could reasonably

21

be expected to reveal the identity of an individual patient.

22

(3)  Any raw data of the council which could reasonably

23

be expected to reveal the identity of any purchaser, as

24

defined in section 3, other than a purchaser requesting data

25

on its own group or an entity entitled to said purchaser's

26

data pursuant to subsection (f).

27

(4)  Any raw data of the council relating to actual

28

payments to any identified provider made by any purchaser,

29

except that this provision shall not apply to access by a

30

purchaser requesting data on the group for which it purchases

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1

or otherwise provides covered services or to access to that

2

same data by an entity entitled to the purchaser's data

3

pursuant to subsection (f).

4

(5)  Any raw data disclosing discounts or [differentials

5

between payments accepted by providers for services and their

6

billed charges obtained by] allowances between identified

7

payors [from identified] and providers unless the data is

8

released in a Statewide, aggregate format that does not

9

identify any individual payor or class of payors, directly or

10

indirectly through the use of a market share, and unless the

11

council assures that the release of such information is not

12

prejudicial or inequitable to any individual payor or

13

provider or group thereof. Payor data shall be released to

14

individual providers for purposes of verification and

15

validation prior to inclusion in a public report. An

16

individual provider shall verify and validate the payor data

17

within 30 days of its release to that specific individual

18

provider.

19

(c)  Unauthorized use of data.--Any person who knowingly

20

releases council data violating the patient confidentiality,

21

actual payments, discount data or raw data safeguards set forth

22

in this section to an unauthorized person commits a misdemeanor

23

of the first degree and shall, upon conviction, be sentenced to

24

pay a fine of $10,000 or to imprisonment for not more than five

25

years, or both. An unauthorized person who knowingly receives or

26

possesses such data commits a misdemeanor of the first degree.

27

(d)  Unauthorized access to data.--Should any person

28

inadvertently or by council error gain access to data that

29

violates the safeguards set forth in this section, the data must

30

immediately be returned, without duplication, to the council

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1

with proper notification.

2

(e)  Public access to records.--All public reports prepared

3

by the council shall be public records and shall be available to

4

the public for a reasonable fee, and copies shall be provided,

5

upon request of the chair, to the Public Health and Welfare

6

Committee of the Senate and the Health and Welfare Committee of

7

the House of Representatives.

8

(f)  Access to raw council data by purchasers.--Pursuant to

9

sections 5(d)(5) and 7(b) and subject to the limitations on

10

access set forth in subsection (b), the council shall provide

11

access to its raw data to purchasers in accordance with the

12

following procedure:

13

(1)  Special reports derived from raw data of the council

14

shall be provided by the council to any purchaser requesting

15

such reports.

16

(2)  A means to enable computer-to-computer access by any

17

purchaser to raw data of the council as defined in section 3

18

shall be developed, adopted and implemented by the council,

19

and the council shall provide such access to its raw data to

20

any purchaser upon request.

21

(3)  In the event that any employer obtains from the

22

council, pursuant to paragraph (1) or (2), data pertaining to

23

its employees and their dependents for whom said employer

24

purchases or otherwise provides covered services as defined

25

in section 3 and who are represented by a certified

26

collective bargaining representative, said collective

27

bargaining representative shall be entitled to that same

28

data, after payment of fees as specified in paragraph (4).

29

Likewise, should a certified collective bargaining

30

representative obtain from the council, pursuant to paragraph

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1

(1) or (2), data pertaining to its members and their

2

dependents who are employed by and for whom covered services

3

are purchased or otherwise provided by any employer, said

4

employer shall be entitled to that same data, after payment

5

of fees as specified in paragraph (4).

6

(4)  In providing for access to its raw data, the council

7

shall charge the purchasers which originally obtained such

8

access a fee sufficient to cover its costs to prepare and

9

provide special reports requested pursuant to paragraph (1)

10

or to provide computer-to-computer access to its raw data

11

requested pursuant to paragraph (2). Should a second or

12

subsequent party or parties request this same information

13

pursuant to paragraph (3), the council shall charge said

14

party a reasonable fee.

15

(g)  Access to raw council data by other parties.--Subject to

16

the limitations on access to raw council data set forth in

17

subsection (b), the council may, at its discretion, provide

18

special reports derived from its raw data or computer-to-

19

computer access to parties other than purchasers. The council

20

shall publish regulations that set forth the criteria and the

21

procedure it shall use in making determinations on such access,

22

pursuant to the powers vested in the council in section 4. In

23

providing such access, the council shall charge the party

24

requesting the access a reasonable fee.

25

Section 5.  Sections 11, 12, 13, 14, 15, 16 and 17.1 of the

26

act are reenacted to read:

27

Section 11.  Special studies and reports.

28

(a)  Special studies.--Any Commonwealth agency may publish or

29

contract for publication of special studies. Any special study

30

so published shall become a public document.

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1

(b)  Special reports.--

2

(1)  Any Commonwealth agency may study and issue a report

3

on the special medical needs, demographic characteristics,

4

access or lack thereof to health care services and need for

5

financing of health care services of:

6

(i)  Senior citizens, particularly low-income senior

7

citizens, senior citizens who are members of minority

8

groups and senior citizens residing in low-income urban

9

or rural areas.

10

(ii)  Low-income urban or rural areas.

11

(iii)  Minority communities.

12

(iv)  Women.

13

(v)  Children

14

(vi)  Unemployed workers.

15

(vii)  Veterans.

16

The reports shall include information on the current

17

availability of services to these targeted parts of the

18

population, and whether access to such services has increased

19

or decreased over the past ten years, and specific

20

recommendations for the improvement of their primary care and

21

health delivery systems, including disease prevention and

22

comprehensive health care services. The department may also

23

study and report on the effects of using prepaid, capitated

24

or HMO health delivery systems as ways to promote the

25

delivery of primary health care services to the underserved

26

segments of the population enumerated above.

27

(2)  The department may study and report on the short-

28

term and long-term fiscal and programmatic impact on the

29

health care consumer of changes in ownership of hospitals

30

from nonprofit to profit, whether through purchase, merger or

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1

the like. The department may also study and report on factors

2

which have the effect of either reducing provider revenue or

3

increasing provider cost, and other factors beyond a

4

provider's control which reduce provider competitiveness in

5

the marketplace, are explained in the reports.

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 may be assessed a civil penalty not to exceed

19

$1,000 for each day the data is not submitted.

20

(2)  Any person who knowingly submits inaccurate data

21

under section 6 commits a misdemeanor of the third degree and

22

shall, upon conviction, be sentenced to pay a fine of $1,000

23

or to imprisonment for not more than one year, or both.

24

Section 13.  Research and demonstration projects.

25

The council shall actively encourage research and

26

demonstrations to design and test improved methods of assessing

27

provider quality, provider service effectiveness and efficiency.

28

To that end, provided that no data submission requirements in a

29

mandated demonstration may exceed the current reserve field on

30

the Pennsylvania Uniform Claims and Billing Form, the council

- 47 -

 


1

may:

2

(1)  Authorize contractors engaged in health services

3

research selected by the council, pursuant to the provisions

4

of section 16, to have access to the council's raw data

5

files, providing such entities assume any contractual

6

obligations imposed by the council to assure patient identity

7

confidentiality.

8

(2)  Place data sources participating in research and

9

demonstrations on different data submission requirements from

10

other data sources in this Commonwealth.

11

(3)  Require data source participation in research and

12

demonstration projects when this is the only testing method

13

the council determines is promising.

14

Section 14.  Grievances and grievance procedures.

15

(a)  Procedures and requirements.--Pursuant to its powers to

16

publish regulations under section 5(b) and with the requirements

17

of this section, the council is hereby authorized and directed

18

to establish procedures and requirements for the filing, hearing

19

and adjudication of grievances against the council of any data

20

source. Such procedures and requirements shall be published in

21

the Pennsylvania Bulletin pursuant to law.

22

(b)  Claims; hearings.--Grievance claims of any data source

23

shall be submitted to the council or to a third party designated

24

by the council, and the council or the designated third party

25

shall convene a hearing, if requested, and adjudicate the

26

grievance.

27

Section 15.  Antitrust provisions.

28

Persons or entities required to submit data or information

29

under this act or receiving data or information from the council

30

in accordance with this act are declared to be acting pursuant

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1

to State requirements embodied in this act and shall be exempt

2

from antitrust claims or actions grounded upon submission or

3

receipt of such data or information.

4

Section 16.  Contracts with vendors.

5

Any contract with any vendor other than a sole source vendor

6

for purchase of services or for purchase or lease of supplies

7

and equipment related to the council's powers and duties shall

8

be let only after a public bidding process and only in

9

accordance with the following provisions, and no contract shall

10

be let by the council that does not conform to these provisions:

11

(1)  The council shall prepare specifications fully

12

describing the services to be rendered or equipment or

13

supplies to be provided by a vendor and shall make these

14

specifications available for inspection by any person at the

15

council's offices during normal working hours and at such

16

other places and such other times as the council deems

17

advisable.

18

(2)  The council shall publish notice of invitations to

19

bid in the Pennsylvania Bulletin. The council shall also

20

publish such notice in at least four newspapers in general

21

circulation in the Commonwealth on at least three occasions

22

at intervals of not less than three days. Said notice shall

23

include at least the following:

24

(i)  The deadline for submission of bids by

25

prospective vendors, which shall be no sooner than 30

26

days following the latest publication of the notice as

27

prescribed in this paragraph.

28

(ii)  The locations, dates and times during which

29

prospective vendors can examine the specifications

30

required in paragraph (1).

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1

(iii)  The date, time and place of the meeting or

2

meetings of the council at which bids will be opened and

3

accepted.

4

(iv)  A statement to the effect that any person is

5

eligible to bid.

6

(3)  Bids shall be accepted as follows:

7

(i)  No council member who is affiliated in any way

8

with any bidder shall vote on the awarding of any

9

contract for which said bidder has submitted a bid, and

10

any council member who has an affiliation with a bidder

11

shall state the nature of the affiliation prior to any

12

vote of the council.

13

(ii)  Bids shall be opened and reviewed by the

14

appropriate council committee, which shall make

15

recommendations to the council on approval. Bids shall be

16

accepted and such acceptance shall be announced only at a

17

public meeting of the council as defined in section 4(e),

18

and no bids shall be accepted at an executive session of

19

the council.

20

(iii)  The council may require that a certified

21

check, in an amount determined by the council, accompany

22

every bid, and, when so required, no bid shall be

23

accepted unless so accompanied.

24

(4)  In order to prevent any party from deliberately

25

underbidding contracts in order to gain or prevent access to

26

council data, the council may award any contract at its

27

discretion, regardless of the amount of the bid, pursuant to

28

the following:

29

(i)  Any bid accepted must reasonably reflect the

30

actual cost of services provided.

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1

(ii)  Any vendor so selected by the council shall be

2

found by the council to be of such character and such

3

integrity as to assure, to the maximum extent possible,

4

adherence to all the provisions of this act in the

5

provision of contracted services.

6

(iii)  The council may require the selected vendor to

7

furnish, within 20 days after the contract has been

8

awarded, a bond with suitable and reasonable requirements

9

guaranteeing the services to be performed with sufficient

10

surety in an amount determined by the council, and upon

11

failure to furnish such bond within the time specified,

12

the previous award shall be void.

13

(5)  The council shall make efforts to assure that its

14

vendors have established affirmative action plans to assure

15

equal opportunity policies for hiring and promoting

16

employees.

17

Section 17.1.  Reporting.

18

The council shall provide an annual report of its financial

19

expenditures to the Appropriations Committee of the Senate and

20

the Appropriations Committee of the House of Representatives.

21

Section 6.  The act is amended by adding a section to read:

22

Section 17.2.  Health Care Cost Containment Council Act Review

23

Committee.

24

(a)  Establishment.--There is established an independent

25

committee to be known as the Health Care Cost Containment

26

Council Act Review Committee.

27

(b)  Composition.--The committee shall consist of the

28

following voting members composed of and appointed as follows:

29

(1)  One member appointed by the Governor.

30

(2)  Four members appointed by the General Assembly, one

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1

of whom appointed by each of the following:

2

(i)  one by the President pro tempore of the Senate;

3

(ii)  one by the Minority Leader of the Senate;

4

(iii)  one by the Majority Leader of the House of

5

Representatives; and

6

(iv)  one by the Minority Leader of the House of

7

Representatives.

8

(3)  Two representatives of the business community, at

9

least one of whom represents small business, and neither of

10

whom is primarily involved in the provision of health care or

11

health insurance, one of whom appointed by the President pro

12

tempore of the Senate and one of whom appointed by the

13

Speaker of the House of Representatives from a list of four

14

qualified persons recommended by the Pennsylvania Chamber of

15

Business and Industry.

16

(4)  Two representatives of organized labor, one of whom

17

appointed by the President pro tempore of the Senate and one

18

of whom appointed by the Speaker of the House of

19

Representatives from a list of four qualified persons

20

recommended by the Pennsylvania AFL-CIO.

21

(5)  One representative of consumers who is not primarily

22

involved in the provision of health care or health care

23

insurance, appointed by the Governor from a list of three

24

qualified persons recommended jointly by the President pro

25

tempore of the Senate and the Speaker of the House of

26

Representatives.

27

(6)  One representative of hospitals a health care

<--

28

facility, appointed by the Governor from a list of three

29

qualified hospital representatives recommended by the

30

Hospital and Health System Association of Pennsylvania.

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1

(7)  One representative of physicians, appointed by the

2

Governor from a list of three qualified physician

3

representatives recommended jointly by the Pennsylvania

4

Medical Society and the Pennsylvania Osteopathic Medical

5

Society.

6

(8)  One representative of nurses, appointed by the

7

Governor from a list of three qualified representatives

8

recommended by the Pennsylvania State Nurses Association.

9

(9)  One representative of the Blue Cross and Blue Shield

10

plans in Pennsylvania, pursuant to 40 Pa.C.S. Ch. 61

<--

11

(relating to Hospital Plan Corporations), appointed by the

12

Governor from a list of three qualified persons recommended

13

jointly by the Blue Cross and Blue Shield plans of

14

Pennsylvania.

15

(10)  One representative of commercial insurance

16

carriers, appointed by the Governor from a list of three

17

qualified persons recommended by the Insurance Federation of

18

Pennsylvania, Inc.

19

(c)  Chairperson.--The appointment made by the Governor under

20

subsection (b)(1) shall serve as chairman of the committee.

21

(d)  Quorum.--Eleven members shall constitute a quorum for

22

the transaction of any business, and action by the majority of

23

the members present at any meeting in which there is a quorum

24

shall be deemed to be action of the committee.

25

(e)  Meetings.--

26

(1)  All meetings of the committee shall be advertised

27

and conducted pursuant to 65 Pa.C.S. Ch. 7 (relating to open

28

meetings).

29

(2)  All action taken by the committee shall be taken in

30

open public session, and action of the committee shall not be

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1

taken except upon the affirmative vote of a majority of the

2

members of the committee present during meetings at which a

3

quorum is present.

4

(f)  Compensation and expenses.--The members of the committee

5

shall not receive a salary or per diem allowance for serving as

6

members of the committee but shall be reimbursed for actual and

7

necessary expenses incurred in the performance of their duties.

8

Expenses may include reimbursement of travel and living expenses

9

while engaged in committee business.

10

(g)  Commencement of committee.--

11

(1)  Within 15 days after the effective date of this

12

section, each organization or individual required to submit a

13

list of recommended persons to the Governor, the President

14

pro tempore of the Senate or the Speaker of the House of

15

Representatives under subsection (b) shall submit the list.

16

(2)  Within 30 days of the effective date of this

17

section, the Governor, the President pro tempore of the

18

Senate and the Speaker of the House of Representatives shall

19

make the appointments called for in subsection (b), and the

20

committee shall begin operations immediately following the

21

appointments.

22

(h)  Responsibilities of the committee.--The committee shall

23

have the following powers and duties:

24

(1)  To study, review and recommend changes to this act.

25

(2)  To accept and review suggested changes to this act

26

submitted by members of the committee.

27

(3)  To approve, by a majority vote of the members of the

28

committee, a report recommending statutory changes to this

29

act. The report shall include, at a minimum, the following:

30

(i)  The establishment of an Internet database for

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1

the general public showing Medicare reimbursement rates

2

for common covered services and treatment.

3

(ii)  In consultation with experts in the fields of

4

quality data and outcome measures, the definition and

5

implementation of:

6

(A)  A methodology by provider type for the

7

council to risk adjust quality data.

8

(B)  A methodology for the council to collect and

9

disseminate data reflecting provider quality and

10

provider service effectiveness.

11

(4)  To submit the report approved under paragraph (3) to

12

the President pro tempore of the Senate and the Speaker of

13

the House of Representatives within six months after the

14

effective date of this section.

15

(i)  Committee support.--The council shall offer staff and

16

administrative support from the council or its work groups

17

necessary for the committee to carry out its duties under this

18

section.

19

Section 7.  Section 18 of the act is reenacted to read:

20

Section 18.  Severability.

21

The provisions of this act are severable. If any provision of

22

this act or its application to any person or circumstance is

23

held invalid, the invalidity shall not affect other provisions

24

or applications of this act which can be given effect without

25

the invalid provision or application.

26

Section 8.  Section 19 of the act is reenacted and amended to

27

read:

28

Section 19.  Sunset.

29

This act shall expire June 30, [2008] 2014, unless reenacted

30

prior to that date. By September 1, [2007] 2013, a written

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1

report by the Legislative Budget and Finance Committee

2

evaluating the management, visibility, awareness and performance

3

of the council shall be provided to the Public Health and

4

Welfare Committee of the Senate and the Health and Human

5

Services Committee of the House of Representatives. The report

6

shall include a review of the council's procedures and policies,

7

the availability and quality of data for completing reports [to

8

hospitals and outside vendor purchasers, the ability of the

9

council to become self-sufficient by selling data to outside

10

purchasers], whether there is a more cost-efficient way of

11

accomplishing the objectives of the council and the need for

12

reauthorization of the council.

13

Section 9.  Section 20 of the act is reenacted to read:

14

Section 20.  Effective date.

15

This act shall take effect immediately.

16

Section 10.  In accordance with section 11 of this act, the

17

following apply to the period from June 29, 2008, to the

18

effective date of this section:

19

(1)  There is no lapse in membership on the Health Care

20

Cost Containment Council.

21

(2)  Eleven members constitute a quorum.

22

(3)  Any action taken by the council is validated.

23

(4)  There shall be no lapse in the employment

24

relationship for employees of the council. This paragraph

25

includes salary, seniority, benefits and retirement

26

eligibility of the employees.

27

Section 11.  This act shall apply as follows:

28

(1)  Except as set forth in paragraph (2), this act shall

29

apply retroactively to June 29, 2008.

30

(2)  The reenactment of section 6 of the act shall apply

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1

retroactively under paragraph (1), but the amendment of

2

section 6 of the act shall apply from the effective date of

3

the amendment under section 12(1) of this act.

4

Section 12.  This act shall take effect as follows:

5

(1)  The amendment of section 6 of the act shall take

6

effect July 1, 2010.

7

(2)  The remainder of this act shall take effect

8

immediately.

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