PRIOR PRINTER'S NO. 2367
PRINTER'S NO. 2547
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1633
Session of
2015
INTRODUCED BY PICKETT, DeLUCA, QUINN, V. BROWN, COHEN, DRISCOLL,
FARRY, GODSHALL, GROVE, HELM, McNEILL, MILLARD, B. MILLER,
THOMAS, YOUNGBLOOD, PASHINSKI, WATSON, MAJOR AND SIMMONS,
OCTOBER 15, 2015
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, NOVEMBER 18, 2015
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for comprehensive health care for
uninsured children; and making a repeal.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 64
CHILDREN'S HEALTH CARE
Sec.
6401. Definitions.
6402. Children's health care.
6403. Children's Health Advisory Council.
6404. Contracts and coverage packages.
6405. Outreach.
6406. Payor of last resort and insurance coverage.
6407. State plan.
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6408. Limitation on expenditure of funds.
6409. Expiration.
§ 6401. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Child." An individual under 19 years of age.
"Contractor." An insurer awarded a contract under section
6404 (relating to contracts and coverage packages) to provide
health care services under this chapter. The term includes an
entity and an entity's subsidiary which is established under
Chapter 61 (relating to hospital plan corporations) or 63
(relating to professional health services plan corporations) ,
the act of May 17, 1921 (P.L.682, No.284), known as The
Insurance Company Law of 1921, or the act of December 29, 1972
(P.L.1701, No.364), known as the Health Maintenance Organization
Act.
"Council." The Children's Health Advisory Council
established in section 6403 (relating to Children's Health
Advisory Council).
"Department." The Department of Human Services of the
Commonwealth.
"EPSDT." Early and periodic screening, diagnosis and
treatment.
"EXPRESS LANE ELIGIBILITY." A PROCESS WHICH PERMITS THE USE
OF FINDINGS FOR ELIGIBILITY FACTORS, INCLUDING INCOME AND
HOUSEHOLD SIZE FROM AN EXPRESS LANE PARTNER ADMINISTERING A
GOVERNMENT PROGRAM.
"EXPRESS LANE PARTNER." AN AGENCY DETERMINING ELIGIBILITY
FOR ASSISTANCE FOR ANY OF THE FOLLOWING PROGRAMS:
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(1) SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP).
(2) CHILD CARE PROVIDED UNDER THE CHILD CARE AND
DEVELOPMENT BLOCK GRANT ACT OF 1990 (PUBLIC LAW 101-508, 42
U.S.C. § 9858 ET SEQ.).
"Fund." The Children's Health Fund.
"Group." A group for which a health insurance policy is
written in this Commonwealth.
"Health service corporation." A professional health service
corporation as defined in section 6302 (relating to
definitions) .
"Healthy Beginnings Program." Medical assistance coverage
for services to children as required under Title XIX for the
following:
(1) Children from birth to one year of age whose family
income is not greater than 185% of the Federal poverty level.
(2) Children one through five years of age whose family
income is not greater than 133% of the Federal poverty level.
(3) Children 6 through 18 years of age whose family
income is not greater than 133% of the Federal poverty level.
"HMO." An entity organized and regulated under the Health
Maintenance Organization Act.
"Hospital." An institution having an organized medical staff
which is engaged primarily in providing to inpatients, by or
under the supervision of physicians, diagnostic and therapeutic
services for the care of injured, disabled, pregnant, diseased
or sick or mentally ill individuals. The term includes
facilities for the diagnosis and treatment of disorders within
the scope of specific medical specialties. The term does not
include facilities caring exclusively for the mentally ill.
"Hospital plan corporation." A hospital plan corporation as
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defined in section 6101 (relating to definitions).
"Insurer." A health insurance entity licensed in this
Commonwealth to issue any individual or group health, sickness
or accident policy or subscriber contract or certificate that
provides medical or health care coverage by a health care
facility or licensed health care provider that is offered or
governed under any of the following:
(1) The Insurance Company Law of 1921.
(2) The Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) Chapter 61 or 63.
"Medicaid." The Federal medical assistance program
established under Title XIX.
"Medical assistance." The State program of medical
assistance established under the act of June 13, 1967 (P.L.31,
No.21), known as the Public Welfare Code.
"Mid-level health professional." A physician assistant,
certified registered nurse practitioner, nurse practitioner or
certified nurse midwife.
"Parent." A NATURAL parent, stepparent, ADOPTIVE PARENT,
guardian or custodian of a child.
"Preexisting condition." A disease or physical condition for
which medical advice or treatment has been received prior to the
effective date of coverage.
"Premium assistance program." A component of a separate
child health program, approved under the State plan, under which
the Commonwealth pays part or all of the premium for an enrollee
or enrollee's group health insurance coverage or coverage under
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a group health plan.
"Prescription drug." A controlled substance, other drug or
device for medication dispensed by order of an appropriately
licensed medical professional.
"Secretary." The Secretary of Human Services OF T HE
COMMONWEALTH .
"Terminate." The term includes cancellation, nonrenewal and
rescission.
"Title XIX." Title XIX of the Social Security Act (49 Stat.
620, 42 U.S.C. § 301 et seq.).
"Title XXI." Title XXI of the Social Security Act.
§ 6402. Children's health care.
(a) Federal funds.--Notwithstanding any other provision of
law, the department shall ensure the receipt of Federal
financial participation under Title XXI for services provided
under this chapter.
(b) General care.--To ensure that inpatient hospital care is
provided to eligible children, each primary care provider
furnishing primary care services shall make necessary
arrangements for admission to the hospital and for necessary
specialty care.
(c) Enrollment.--
(1) Subject to the provisions of section 6404 (relating
to contracts and coverage packages), an insurer receiving
funds from the department to provide coverage of health care
services under this section shall enroll, to the extent that
funds are available, any child who meets all of the
following:
(i) Is a resident of this Commonwealth.
(ii) Is not:
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(A) Covered by a health insurance plan.
(B) Covered by a self-insurance plan.
(C) Covered by a self-funded plan.
(D) Provided access to health care coverage by
court order.
(E) Eligible for or covered by a medical
assistance program administered by the department,
including the Healthy Beginnings Program.
(iii) Is qualified based on income under subsections
(d) and (e).
(iv) Meets the citizenship requirements of Title
XXI.
(2) Enrollment may not be denied on the basis of a
preexisting condition and diagnosis or treatment for the
condition may not be excluded based on the condition's
preexistence.
(C) ENROLLMENT.--SUBJECT TO THE PROVISIONS OF SECTION 6404
(RELATING TO CONTRACTS AND COVERAGE PACKAGES), AN INSURER
RECEIVING FUNDS FROM THE DEPARTMENT TO PROVIDE COVERAGE OF
HEALTH CARE SERVICES UNDER THIS SECTION SHALL ENROLL, TO THE
EXTENT THAT FUNDS ARE AVAILABLE, ANY CHILD WHO MEETS ALL OF THE
FOLLOWING:
(1) IS A RESIDENT OF THIS COMMONWEALTH.
(2) IS NOT:
(I) COVERED BY A HEALTH INSURANCE PLAN.
(II) COVERED BY A SELF-INSURANCE PLAN.
(III) COVERED BY A SELF-FUNDED PLAN.
(IV) PROVIDED ACCESS TO HEALTH CARE COVERAGE BY
COURT ORDER.
(V) ELIGIBLE FOR OR COVERED BY A MEDICAL ASSISTANCE
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PROGRAM ADMINISTERED BY THE DEPARTMENT, INCLUDING THE
HEALTHY BEGINNINGS PROGRAM.
(3) IS QUALIFIED BASED ON INCOME UNDER SUBSECTIONS (D)
AND (E).
(4) MEETS THE CITIZENSHIP REQUIREMENTS OF TITLE XXI.
(d) Income levels.--The provision of health care insurance
for eligible children shall be in accordance with the following:
(1) Free to a child whose family income is no greater
than 200% of the Federal poverty level.
(2) May be subsidized by the fund at a rate not to
exceed 75% of the per member per month premium cost for a
child whose family income is greater than 200% of the Federal
poverty level but not greater than 250% of the Federal
poverty level.
(3) May be subsidized by the fund at a rate not to
exceed 65% of the per member per month premium cost for a
child whose family income is greater than 250% of the Federal
poverty level but not greater than 275% of the Federal
poverty level.
(4) May be subsidized by the fund at a rate not to
exceed 60% of the per member per month premium for a child
whose family income is greater than 275% of the Federal
poverty level but not greater than 300% of the Federal
poverty level.
(e) Income exceeding limits.--The following apply:
(1) For an eligible child whose family income is greater
than the maximum level established under section 6404(h), the
family may purchase the minimum coverage package under
6404(e)(9) for that child at the per member per month premium
cost. The cost shall be derived separately from the other
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eligibility categories in the program. The family may
purchase the minimum coverage package if the family
demonstrates on an annual basis and in a manner determined by
the department that the family is unable to afford individual
or group coverage because of one of the following reasons:
(i) The coverage would exceed 10% of the family
income.
(ii) The total cost of coverage for the child is
150% of the greater of:
(A) the premium cost established under this
subsection for that service area; or
(B) the premium cost established under the
program for that service area.
(2) For purposes of this subsection, the term "coverage"
may not include coverage offered through accident only, fixed
indemnity, limited benefit, credit, dental, vision, specified
disease, Medicare supplement, Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement, long-
term care or disability income, workers' compensation or
automobile medical payment insurance.
(f) Powers and duties.--
(1) For enrollees under subsection (d)(2), (3) or (4) or
(e), the following apply:
(i) The department may impose copayments for the
following services, except as otherwise prohibited by
law:
(A) Outpatient visits.
(B) Emergency room visits.
(C) Prescription medications.
(D) Any other service defined by the department.
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(ii) The department shall have the authority to
establish and adjust the levels of these copayments in
order to impose reasonable cost sharing and to encourage
appropriate utilization of these services. The premiums
and copayments for enrollees under subsection (d)(2), (3)
or (4) may not amount to more than the percent of total
household income which is in accordance with the
requirements of the Centers for Medicare and Medicaid
Services.
(2) The department shall:
(i) Administer the children's health insurance
program in accordance with this chapter.
(ii) Review all bids and approve and execute all
contracts for the purpose of expanding access to health
care services for eligible children as provided for in
this chapter.
(iii) Conduct monitoring and oversight of contracts.
(iv) Issue an annual report to the Governor, the
General Assembly and the public for each calendar year no
later than March 1 of each year providing for the
following:
(A) The primary health services funded for the
year.
(B) The outreach and enrollment efforts and the
number of children by county and by percent of the
Federal poverty level who are receiving health care
services.
(C) The projected number of eligible children by
county and by percent of the Federal poverty level.
(D) The number of eligible children on waiting
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lists for enrollment in the children's health
insurance program established under this chapter by
county and by percent of the Federal poverty level.
(E) THE DETAILS OF THE DEPARTMENT'S EFFORTS ON
THE IMPLEMENTATION OF EXPRESS LANE ELIGIBILITY.
(v) In consultation with appropriate Commonwealth
agencies, coordinate the development and supervision of
the outreach plan required under section 6405 (relating
to outreach).
(vi) In consultation with appropriate Commonwealth
agencies, monitor, review and evaluate the adequacy,
accessibility and availability of services delivered to
children who are enrolled in the children's health
insurance program established under this chapter.
(vii) Enter into arrangements, including memoranda
of understanding, with the Insurance Department and other
appropriate Federal or State agencies, as may be
necessary to carry out the department's duties under this
chapter.
(3) The department may promulgate regulations necessary
for the implementation and administration of this chapter.
§ 6403. Children's Health Advisory Council.
The Children's Health Advisory Council is established within
the department as an advisory council. The following apply:
(1) The council shall consist of 14 16 voting members.
Members provided for in subparagraphs (iv), (v), (vi), (vii),
(viii), (xiii) and (xiv) , (XIV), (XV) AND (XVI) shall be
appointed by the secretary. The council shall be
geographically balanced on a Statewide basis and shall
include:
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(i) The Secretary of Health ex officio or a
designee.
(ii) The Insurance Commissioner ex officio or a
designee.
(iii) The secretary ex officio or a designee.
(iv) A representative with experience in children's
health from a school of public health located in this
Commonwealth.
(v) A physician with experience in children's health
appointed from a list of three qualified persons
recommended by the Pennsylvania Medical Society.
(vi) A representative of a children's hospital or a
hospital with a pediatric outpatient clinic appointed
from a list of three persons submitted by the Hospital
Association of Pennsylvania.
(vii) A parent of a child who receives primary
health care coverage from the fund.
(viii) A mid-level professional appointed from lists
of names recommended by Statewide associations
representing mid-level health professionals.
(ix) A senator appointed by the President pro
tempore of the Senate.
(x) A senator appointed by the Minority Leader of
the Senate.
(xi) A representative appointed by the Speaker of
the House of Representatives.
(xii) A representative appointed by the Minority
Leader of the House of Representatives.
(xiii) A representative from a private nonprofit
foundation.
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(xiv) A representative of business who is not a
contractor or provider of primary health care insurance
under this chapter.
(XV) A REPRESENTATIVE OF A NONPROFIT BUSINESS WHO IS
A CONTRACTOR OR PROVIDER OF PRIMARY HEALTH INSURANCE
UNDER THIS CHAPTER.
(XVI) A REPRESENTATIVE OF A FOR PROFIT BUSINESS WHO
IS A CONTRACTOR OR PROVIDER OF PRIMARY HEALTH INSURANCE
UNDER THIS CHAPTER.
(2) If a specified organization ceases to exist or fails
to make a recommendation within 90 days of a request, the
council shall specify a new equivalent organization to
fulfill the responsibilities of this section.
(3) The secretary shall serve as chairperson of the
council. The members of the council shall annually elect, by
a majority vote of the members, a vice chairperson from among
the members of the council.
(4) The presence of eight members shall constitute a
quorum for the transacting of any business. An act by a
majority of the members present at a meeting at which there
is a quorum shall be deemed to be that of the council.
(5) All meetings of the council shall be conducted in
accordance with 65 Pa.C.S. Ch. 7 (relating to open meetings),
except as provided in this section. Meetings must be in
accordance with the following:
(i) The council shall meet at least twice per year
and may provide for special meetings as the council deems
necessary.
(ii) Meeting dates shall be set by a majority vote
of members of the council or by call of the chairperson
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upon seven days' notice to all members.
(iii) The council shall publish notice of the
council's meetings in the Pennsylvania Bulletin. The
notice must specify the date, time and place of the
meeting and shall state that the council's meetings are
open to the general public.
(iv) All action taken by the council shall be taken
in open public session and may not be taken except upon a
majority vote of the members present at a meeting at
which a quorum is present.
(6) The members of the council may not receive a salary
or per diem allowance for serving as members of the council
but shall be reimbursed for actual and necessary expenses
incurred in the performance of the members' duties.
(7) Terms of council members shall be as follows:
(i) The appointed members shall serve for a term of
three years and shall continue to serve until a successor
is appointed.
(ii) An appointed member may not be eligible to
serve more than two full consecutive terms of three
years. Vacancies shall be filled in the same manner as
the original appointment within 60 days of the vacancy.
(iii) An appointed member may be removed by the
appointing authority for just cause and by a vote of at
least seven members of the council.
(8) The council shall review outreach activities and may
make recommendations to the department.
(9) The council shall review and evaluate the
accessibility and availability of services delivered to
children enrolled in the program.
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§ 6404. Contracts and coverage packages.
(a) Paid from fund.--In addition to a ny other requirements
provided by law, the fund shall be operated in accordance with
the following:
(1) The fund must be dedicated exclusively for
distribution by the department through contracts in order to
provide free and subsidized health care services under this
chapter, based on an actuarially sound and adequate review,
and to develop and implement outreach activities required
under section 6405 (relating to outreach).
(2) The fund, along with Federal, State and other funds
available for the program, must be used for health care
coverage for children as specified in this chapter. The
department shall ensure that the program is implemented
Statewide.
(3) The departme nt must award contracts paid from the
fund in accordance with the following:
(i) All contracts awarded under this subsection must
be awarded through a competitive procurement process. The
department and the Insurance Department must use their
best efforts to ensure that eligible children across this
Commonwealth have access to health care services to be
provided under this chapter.
(ii) No more than 10% of the amount of the contract
may be used for administrative expenses of the
contractor. If a contractor presents documented evidence
that administrative expenses for purposes of expanded
outreach and systems and operational changes are in
excess of 10% of the amount of the contract, the
department shall make an additional allotment of funds,
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not to exceed 2% of the amount of the contract, to the
contractor to the extent that the department finds the
expenses reasonable and necessary.
(iii) At least 84% of the amount of the contract
shall be used to provide health care services for
children eligible for care under this chapter.
(b) Solicitation of contracts.--The department must solicit
bids and award contracts through a competitive procurement
process in accordance with the following:
(1) To the fullest extent practicable, contracts shall
be awarded to insurers that contract with providers to
provide primary care services for enrollees on a cost-
effective basis. The department shall require contractors to
use appropriate cost-management methods so that basic primary
coverage services can be provided to the maximum number of
eligible children and, if possible, to pursue and utilize
available public and private funds.
(2) To the fullest extent practicable, the department
must require that a contractor comply with all procedures
relating to coordination of health care services as required
by the department or the Insurance Department.
(3) Contracts may be for a term of up to three years,
with the option to extend for two one-year periods.
(c) Bidding.--Upon receipt of a solicitation from the
department, each health service corporation and hospital plan
corporation or their entities doing business in this
Commonwealth shall submit a bid or proposal to the department to
carry out the purposes of this chapter in the area serviced by
the corporation.
(d) Bidding by other insurers.--All other insurers may
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submit a bid or proposal to the department to carry out the
purposes of this chapter.
(e) Duties of contractor.--A contractor with whom the
department enters into a contract shall do the following:
(1) Ensure to the maximum extent possible that eligible
children have access to primary health care physicians and
nurse practitioners within the contractor's service area.
(2) Contract with qualified, cost-effective providers,
which may include primary health care physicians, nurse
practitioners, clinics and HMOs, to provide primary and
preventive health care for enrollees on a basis best
calculated to manage the costs of the services, including,
but not limited to, using managed health care techniques and
other appropriate medical cost-management methods.
(3) Ensure that the family of a child who may be
eligible for medical assistance receives assistance in
applying for medical assistance.
(4) Maintain waiting lists of children financially
eligible for coverage who have applied for coverage but who
were not enrolled due to lack of funds.
(5) Notify families of children who are paying a premium
of any changes in such premium or copayment requirements.
(6) Collect premiums or copayments from the family of a
child receiving coverage as may be required.
(7) Cancel coverage for nonpayment of premium, in
accordance with all applicable insurance laws.
(8) Strongly encourage all providers who provide primary
care to eligible children to participate in medical
assistance as qualified EPSDT providers and to continue to
provide care to children who become ineligible for coverage
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under the provisions of this chapter but who qualify for
medical assistance.
(9) Subject to any necessary Federal approval, provide
the following minimum coverage package , WHICH MAY NOT
CONFLICT WITH FEDERAL LAW, REGULATION OR GUIDANCE, for
eligible children:
(i) Preventive care. This subparagraph shall
include:
(A) Well-child care visits in accordance with
the schedule established by the American Academy of
Pediatrics and the services related to the visits,
including immunizations, health education,
tuberculosis testing and developmental screening in
accordance with the routine schedule of well-child
care visits.
(B) A comprehensive physical examination,
including X-rays if necessary, for any child
exhibiting symptoms of possible child abuse.
(ii) Diagnosis and treatment of illness or injury,
including all medically necessary services related to the
diagnosis and treatment of sickness and injury and other
conditions provided on an ambulatory basis, such as
laboratory tests, wound dressing and casting to
immobilize fractures.
(iii) Injections and medications provided at the
time of the office visit or therapy and outpatient
surgery performed in the office, a hospital or
freestanding ambulatory service center, including
anesthesia provided in conjunction with such service or
during emergency medical service.
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(iv) Emergency accident and emergency medical care.
(v) Prescription drugs.
(vi) Emergency, preventive and routine dental care.
This subparagraph does not include orthodontia or
cosmetic surgery.
(vii) Emergency, preventive and routine vision care,
including the cost of corrective lenses and frames, not
to exceed two prescriptions per year.
(viii) Emergency, preventive and routine hearing
care.
(ix) Inpatient hospitalization up to 90 days per
year for eligible children .
(10) The department may implement a premium assistance
program permitted under Federal regulations and as permitted
through Federal waiver or State plan amendment made pursuant
to this chapter. Notwithstanding any other law to the
contrary, if it is more cost effective to purchase health
care from a parent's employer-based program and the employer-
based program meets the minimum coverage requirements,
employer-based coverage may be purchased in place of
enrollment in the children's health insurance program
established under this chapter. An insurer must honor a
request for enrollment and purchase of employee group health
insurance requested on behalf of an individual applying for
coverage under this chapter if the individual:
(i) is a resident of this Commonwealth;
(ii) is qualified based on income under section
6402 (d) (relating to children's health care) ; and
(iii) meets the citizenship requirements of section
6402 (c)(1)(iv).
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(11) The department shall have the authority to review,
audit and approve annual administrative expenses incurred by
contractors under this section.
(12) Except for children covered under paragraph (10),
each contractor shall provide a coverage identification card
to each eligible child covered under contracts executed under
this chapter. The card must not specifically identify the
holder as low income.
(f) Waiver of minimum.--The department may grant a waiver of
the minimum coverage package of subsection (e)(9) upon
demonstration by the applicant that the applicant is providing
health care services for eligible children that meet the
purposes and intent of this chapter.
(g) Review.--The department, in consultation with
appropriate Commonwealth agencies, must review enrollment
patterns for both the free coverage program and the subsidized
coverage program. The department shall consider the
relationship, if any, among enrollment, enrollment fees, income
levels and family composition. Based on the results of this
study and the availability of funds, the department is
authorized to adjust the maximum income ceiling for free
coverage and the maximum income ceiling for subsidized coverage
by regulation. The maximum income ceiling for free coverage may
not be raised above 200% of the Federal poverty level.
(h) Limit.--Notwithstanding subsection (g) and subject to
section 6407 (relating to State plan), the maximum income
ceiling for subsidized coverage under section 6402(d)(2), (3) or
(4) may not be raised above 300% of the Federal poverty level.
§ 6405. Outreach.
(a) Plan.--The department, in consultation with appropriate
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Commonwealth agencies, must coordinate the development of an
outreach plan to inform potential contractors, providers and
enrollees regarding eligibility and available coverage. The plan
must include provisions for all of the following:
(1) Reaching special populations, including nonwhite and
non-English-speaking children and children with disabilities.
(2) Reaching different geographic areas, including rural
and inner-city areas.
(3) Ensuring that special efforts are coordinated within
the overall outreach activities throughout this Commonwealth.
(4) COMPARING CHILDREN ENROLLED IN CHILD CARE PROVIDED
UNDER THE CHILD CARE AND DEVELOPMENT BLOCK GRANT ACT OF 1990
(PUBLIC LAW 101-508, 42 U.S.C. § 9858 ET SEQ.) OR ENROLLED IN
THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM IN THE
DETERMINATION OF A CHILD'S ELIGIBILITY FOR COVERAGE UNDER
THIS CHAPTER AND IMPLEMENT EXPRESS LANE ELIGIBILITY AS
APPROPRIATE. THE DEPARTMENT IS AUTHORIZED TO EXPAND THE
AGENCIES IDENTIFIED AS EXPRESS LANE PARTNERS BY THE ISSUANCE
OF A STATEMENT OF POLICY.
(5) NOTICE OF THE EXISTENCE OF AND ELIGIBILITY FOR THE
PROGRAM SHALL BE PREPARED BY THE DEPARTMENT AND PROVIDED TO
THE DEPARTMENT OF EDUCATION FOR DISSEMINATION TO NONPUBLIC
AND PUBLIC SCHOOLS ELECTRONICALLY, ON AN ANNUAL BASIS, NOT
LATER THAN AUGUST 15.
(b) Review.--The council shall review the outreach
activities and recommend changes as the council deems to be in
the best interests of the children to be served.
§ 6406. Payor of last resort and insurance coverage.
The contractor may not pay a claim on behalf of an enrolled
child unless all other Federal, State, local or private
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resources available to the child or the child's family are
utilized first. The department, in cooperation with the
Insurance Department, must determine if insurance coverage is
available to the child through a custodial or noncustodial
parent on an employment-related or other group basis. If
insurance coverage is available, the child's eligibility under
section 6402 (relating to children's health care) and the most
cost-effective means of providing coverage for that child must
be reevaluated.
§ 6407. State plan.
The department may amend the State plan as necessary to carry
out the provisions of this chapter.
§ 6408. Limitation on expenditure of funds.
The total amount of annual contract awards authorized under
this chapter may not exceed the amount of cigarette tax receipts
annually deposited into the fund under section 1296 of the act
of March 4, 1971 (P.L.6, No.2), known as the Tax Reform Code of
1971, and any other Federal or State funds received through the
fund. The provision of children's health care through the fund
may not constitute an entitlement derived from the Commonwealth
or a claim on any other funds of the Commonwealth.
§ 6409. Expiration.
(a) General rule.--This chapter shall expire on the earlier
of:
(1) December 31, 2017.
(2) Ninety days after the date on which Federal funding
for the program ceases to be available.
(b) Notice.--If the chapter expires under subsection (a)(2),
as determined by the department, the department shall transmit
notice to the Legislative Reference Bureau for publication in
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the Pennsylvania Bulletin.
Section 2. Repeals are as follows:
(1) The General Assembly declares that the repeal under
paragraph (2) is necessary to effectuate the addition of 40
Pa.C.S. Ch. 64.
(2) Article XXIII of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921, is
repealed.
Section 3. The addition of 40 Pa.C.S. Ch. 64 is a
continuation of Article XXIII of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921.
The following apply:
(1) Except as otherwise provided in 40 Pa.C.S. Ch. 64,
all activities initiated under Article XXIII shall continue
and remain in full force and effect and may be completed
under 40 Pa.C.S. Ch. 64. Orders, regulations, rules and
decisions which were made under Article XXIII and which are
in effect on the effective date of section 2(2) of this act
shall remain in full force and effect until revoked, vacated
or modified under 40 Pa.C.S. Ch. 64. Contracts and
obligations entered into under Article XXIII are not affected
nor impaired by the repeal of Article XXIII.
(2) Except as set forth in paragraph (3), any difference
in language between 40 Pa.C.S. Ch. 64 and Article XXIII is
intended only to conform to the style of the Pennsylvania
Consolidated Statutes and is not intended to change or affect
the legislative intent, judicial construction or
administration and implementation of Article XXIII.
(3) Paragraph (2) does not apply to the addition of the
following provisions:
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(i) The change in the definition of "department" in
40 Pa.C.S. § 6401.
(ii) The provisions for arrangements with other
agencies under 40 Pa.C.S. § 6402(f)(2)(vii).
(iii) The expiration provision under 40 Pa.C.S. §
6409.
(4) All entities receiving grants under Article XXIII on
the effective date of this section shall continue to receive
funds and provide services as required under Article XXIII
until notice from the Department of Human Services is
published in the Pennsylvania Bulletin.
Section 4. This act shall take effect immediately.
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