Bill Text: PA HB1 | 2009-2010 | Regular Session | Amended

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Bill Title: Establishing the Expanded Adult Basic Coverage Insurance Program and the Physician Retention Loan Forgiveness Program in the Pennsylvania Higher Education Assistance Agency; providing for powers and duties of the Pennsylvania Higher Education Assistance Agency and for health care coverage for telehealth; establishing the Hospital Electronic Information Incentive Payment Program and the Dentists for Medical Assistance Patients Program in the Department of Public Welfare; making appropriations; and making related repeals.

Spectrum: Partisan Bill (Democrat 42-1)

Status: (Engrossed - Dead) 2009-07-01 - Referred to BANKING AND INSURANCE [HB1 Detail]

Download: Pennsylvania-2009-HB1-Amended.html

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PRIOR PRINTER'S NOS. 1871, 1872 PRINTER'S NO. 2098
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1 Session of2009
INTRODUCED BY EACHUS, DeLUCA, DeWEESE, BISHOP, BRIGGS, CALTAGIRONE, DALEY, DONATUCCI, FRANKEL, GIBBONS, GRUCELLA, HARHAI, HOUGHTON, MARKOSEK, McGEEHAN, McILVAINE SMITH, MELIO, READSHAW, SANTARSIERO, SEIP, SIPTROTH, SOLOBAY, STABACK, MANDERINO, YUDICHAK, DePASQUALE, BRENNAN, McCALL, CONKLIN, KULA, BELFANTI, SANTONI, M. O'BRIEN, JOSEPHS, R. TAYLOR, MUNDY, MURPHY, JOHNSON, CARROLL, YOUNGBLOOD, THOMAS AND FREEMAN, MAY 21, 2009
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, JUNE 10, 2009
AN ACT
Establishing the Expanded Adult Basic Coverage Insurance Program
and the Physician Retention Loan Forgiveness Program in the <--
Pennsylvania Higher Education Assistance Agency; providing
for powers and duties of the Pennsylvania Higher Education
Assistance Agency and for health care coverage for
telehealth; establishing the Hospital Electronic Information
Incentive Payment Program and the Dentists for Medical
Assistance Patients Program in the Department of Public
Welfare; making appropriations; and making related repeals.
TABLE OF CONTENTS
Chapter 1. Preliminary Provisions
Section 101. Short title.
Section 102. Definitions.
Chapter 3. Pennsylvania Expanded Adult Basic Coverage Insurance
Program
Section 301. Scope of chapter.
Section 302. Definitions.
Section 303. Pennsylvania Expanded Adult Basic Coverage
Insurance Program.
Section 304. Duties of contractors.
Section 305. Premiums and charges.
Section 306. Data matching.
Section 307. Information sharing.
Section 308. Regulations.
Section 309. Funding.
Section 310. Federal waivers or State plan amendments.
Section 311. Federal funds.
Section 312. Federal programs.
Section 313. Establishment.
Section 314. Deposits into fund and appropriation.
Section 315. Certain children of insured parents. <--
Chapter 5. Physician Retention Loan Forgiveness
Section 501. Purpose.
Section 502. Definitions.
Section 503. Program.
Section 504. Amount of loan forgiveness.
Section 505. Contract.
Section 506. Disqualification.
Section 507. Tax consequences.
Section 508. Regulations.
Section 509. Funding.
Chapter 7. Telehealth
Section 701. Definitions.
Section 702. Provision of coverage.
Chapter 41. Hospital Electronic Information Incentive Payment
Program
Section 4101. Scope of chapter.
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Section 4102. Definitions.
Section 4103. Hospital Electronic Information Incentive Payment
Program.
Chapter 43. Dentists for Medical Assistance Patients
Section 4301. Scope of chapter.
Section 4302. Purpose.
Section 4303. Definitions.
Section 4304. Program.
Section 4305. Contract.
Section 4306. Funding.
Section 4307. Reporting requirements.
Section 4308. Regulations.
Chapter 51. Miscellaneous Provisions
Section 5101. Repeals.
Section 5102. Effective date.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
CHAPTER 1
PRELIMINARY PROVISIONS
Section 101. Short title.
This act shall be known and may be cited as the Expanded
Adult Basic Coverage Insurance Program Act.
Section 102. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Department." The Insurance Department of the Commonwealth.
CHAPTER 3
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PENNSYLVANIA EXPANDED ADULT BASIC COVERAGE INSURANCE PROGRAM
Section 301. Scope of chapter.
This chapter relates to offering health care coverage to
eligible adults.
Section 302. 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:
"Behavioral health services." Mental health or substance
abuse services.
"Benefit package." Insurance coverage which provides the
benefits set forth under section 303(h) for eligible adults.
"Children's Health Insurance Program." The Children's Health
Care Program established under Article XXIII of the act of May
17, 1921 (P.L.682, No.284), known as The Insurance Company Law
of 1921.
"Chronic care and disease management." A model of health
care that manages chronic diseases in accordance with evidence-
based treatment guidelines and includes all of the following:
(1) Planned, regular interactions with caregivers to
systematically assess the patient's condition and guide
patient self-care to prevent exacerbation and complications
of the chronic illness.
(2) Support for the patient's role as self-manager
through education and continuing follow-up initiated by the
health care practice.
(3) Use of information systems to organize care and
monitor patient progress.
"Contractor." An insurer or other entity or its subsidiaries
awarded a contract to provide health care services under this
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chapter.
"Eligible adult." A low-income adult who meets all of the
following:
(1) Legally resides within the United States or has <--
permanent legal alien status.
(2) Is a resident of this Commonwealth at the time of
application to the program.
(3) Is not currently covered by a health insurance plan,
a self-insurance plan or a self-funded plan and does not <--
qualify for health insurance as a child of an insured parent
under section 315.
(4) Has not been covered by a health insurance plan, a
self-insurance plan or a self-funded plan during the six
months immediately preceding the determination of
eligibility, except if one of the following apply:
(i) The low-income adult is eligible to receive
benefits under the act of December 5, 1936 (2nd Sp.Sess.,
1937 P.L.2897, No.1), known as the Unemployment
Compensation Law.
(ii) The low-income adult was covered under a health
insurance plan, a self-insurance plan or a self-funded
plan, but, at the time of application for coverage, is no
longer employed and is ineligible to receive benefits
under the Unemployment Compensation Law.
(iii) The low-income adult lost coverage as a result
of divorce or separation from a covered individual or the
death of a covered individual.
(iv) The low-income adult lost coverage as a result
of a change in employment status of a covered individual
resulting in either of the exceptions set forth under
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subparagraph (i) or (ii) and both the eligible adult and
the spouse are low-income adults and applying for
coverage.
(v) The low-income adult is transferring from
another government-subsidized health insurance program,
including a transfer that occurs as a result of failure
to meet income eligibility requirements.
(5) The low-income adult is ineligible to receive
continuous eligibility coverage under Title XIX or XXI of the
Social Security Act (49 Stat. 620, 42 U.S.C. § 301 et seq.),
except for benefits authorized under a waiver granted by the
United States Department of Health and Human Services to
implement the program.
(6) The low-income adult is ineligible for Medicare.
"Enrollee." An eligible adult who meets all the requirements
of this chapter and is enrolled in the Pennsylvania Expanded
Adult Basic Coverage Insurance Program.
"Health benefit plan." An insurance coverage plan that
provides the benefits set forth under section 303(h). The term
shall not include any of the following:
(1) An accident-only policy.
(2) A credit-only policy.
(3) A long-term care or disability income policy.
(4) A specified-disease policy.
(5) A Medicare supplement policy.
(6) A Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement policy.
(7) A fixed-indemnity policy.
(8) A dental-only policy.
(9) A vision-only policy.
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(10) A workers' compensation policy.
(11) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(12) Other similar policies providing for limited
benefits.
"Health maintenance organization" or "HMO." An entity
organized and regulated under the act of December 29, 1972
(P.L.1701, No.364), known as the Health Maintenance Organization
Act.
"Hospital." A hospital as defined and licensed under the act
of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Hospital plan corporation." A hospital plan corporation as
defined in 40 Pa.C.S. § 6101 (relating to definitions).
"Insurer." A company or health insurance entity licensed in
this Commonwealth to issue any individual or group health,
sickness or accident policy or subscriber contract or
certificate or plan 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 act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as 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) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
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"Low-income adult." An individual who is at least 19 years
of age but less than 65 years of age and whose household income
is less than 200% of the Federal poverty level at the time of
eligibility determination.
"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.
"Medicare." The Federal program established under Title
XVIII of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1395
et seq.).
"Offeror." An insurer that submits a bid or proposal in
response to a solicitation request for proposals issued under <--
section 303(h).
"Pre-existing condition." A disease or physical condition
for which medical advice, diagnosis, care or treatment was
recommended or received prior to the effective date of coverage.
"Premium assistance program." A component of the
Pennsylvania Expanded Adult Basic Coverage Insurance Program,
approved under a State plan or approved waiver, under which the
Commonwealth pays part or all of the premium for an enrollee’s
group health insurance or coverage under a group health plan.
"Prescription drug." A controlled substance, other drug or
device for medication dispensed by order of an appropriately
licensed medical professional.
"Professional health services plan corporation." A not-for-
profit corporation operating under the provisions of 40 Pa.C.S.
Ch. 63 (relating to professional health services plan
corporations).
"Program." The Pennsylvania Expanded Adult Basic Coverage
Insurance Program.
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"Unemployment Compensation Law." The act of December 5, 1936
(1937 2nd Sp.Sess., P.L.2897, No.1), known as the Unemployment
Compensation Law.
"Wait-list enrollee." An eligible adult who meets all the
requirements of this chapter who is not enrolled in the program
due to insufficient appropriations, but who individually
purchases the benefit package.
Section 303. Pennsylvania Expanded Adult Basic Coverage
Insurance Program.
(a) Program establishment.--There is established in the
department the Pennsylvania Expanded Adult Basic Coverage
Insurance Program. The program is contingent on, and shall not
be authorized without, sufficient Federal financial
participation to fund the program. Appropriations to the
department for the program shall be used for contracts to
provide basic health care insurance for eligible adults and
administration of outreach activities and for program operating <--
costs. The department shall, to the greatest extent practicable,
ensure that all eligible adults in this Commonwealth have access
to the program established in this section.
(b) Eligible adult responsibilities.--An eligible adult
seeking to purchase coverage under the program shall:
(1) Submit an application to the department or a
contractor.
(2) Pay to the department, or the contractor with whom
the eligible adult is to be enrolled, the amount of the
premium specified under this subsection. Except to the extent
that changes may be necessary to meet Federal requirements
under section 310, subsidies for the 2009-2010 fiscal year
shall result in the following premium amount based on
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household income for a health benefit plan:
(i) For an enrollee whose household income is not
greater than 150% of the Federal poverty level, a monthly
premium of $0.
(ii) For an enrollee whose household income is
greater than 150% but not greater than 175% of the
Federal poverty level, a monthly premium of $40.
(iii) For an enrollee whose household income is
greater than 175% but not greater than 200% of the
Federal poverty level, a monthly premium of $50.
(3) Be responsible for any required copayments for
health care services rendered under the benefit package in
subsection (h).
(4) Notify the department or the contractor with whom
the eligible adult is enrolled of any change in the eligible
adult's household income.
(c) Purchase of insurance.--An eligible adult's payment to
the department or the contractor with whom the eligible adult is
enrolled under subsection (b)(2) shall be used to purchase the
benefit package and shall be remitted so that it is received by
the department or the contractor before the first day of the
month for which coverage is provided. A grace period for
remittance shall be permitted as provided by Federal or State
law.
(d) Premium assistance program.--The department shall
implement a premium assistance program permitted under Federal
regulations and as permitted through a Federal waiver or State
plan amendment made under this chapter. Notwithstanding any
other law to the contrary, in the event that it is more cost-
effective to purchase health care from an enrollee's employer-
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based program and the employer-based program provides, at a
minimum, the benefits package described in subsection (h)(8),
employer-based coverage may be purchased in place of enrollment
in the program established under this chapter. An insurer shall
honor a request for enrollment and purchase of employee group
health insurance requested on behalf of an enrollee.
(e) Waiting list.—-The department shall maintain a waiting
list of eligible adults who have applied for coverage a health <--
benefit plan under the program but who are not enrolled due to
insufficient appropriations. An eligible adult on the waiting
list may purchase the benefit package at the monthly per-member
premium cost negotiated by the department. The department shall
create a procedure to remove eligible adults from the waiting
list and enroll them in the program based upon available
funding.
(f) Entitlements and claims.--Nothing in this chapter shall
constitute an entitlement derived from the Commonwealth or a
claim on any funds of the Commonwealth. The Department of Public
Welfare, in conjunction with the department, shall seek approval
of State plan amendments and revisions to Federal waivers as are
necessary to ensure that expenditures in the program shall not
exceed available funding.
(g) Department responsibilities.--The department shall work
in consultation and cooperation with other appropriate
Commonwealth agencies, including the Department of Public
Welfare, to carry out the functions of this chapter and shall:
(1) Administer the program on a Statewide basis.
(2) Enter into contracts for health care insurance for <--
the benefit package in accordance with 62 Pa.C.S. (relating <--
to procurement). Contracts may be awarded on a multiple-
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award basis.
(3) (i) In order to effectuate the program promptly
upon receipt of all applicable waivers and approvals from
the Federal government, contracts as currently exist
under the Adult Basic Program or the Physical Health
Health Choices Program of the Department of Public
Welfare may be amended to provide benefits under the
program established in this section or may otherwise
procure services outside the competitive procurement
process.
(ii) This paragraph shall expire at the same time as
the contracts awarded under this section, but not later
than 18 months after the effective date of this section.
(4) Subject to Federal requirements, impose reasonable
cost-sharing arrangements establishing and adjusting
copayments to be incorporated into the program by
contractors, thereby encouraging appropriate use by
contractors of cost-effective health care providers who will
provide quality health care. Changes to copayments shall be
forwarded to the Legislative Reference Bureau for publication
as notices in the Pennsylvania Bulletin.
(5) Conduct monitoring, oversight and audits of executed
contracts for enforcement purposes.
(6) Ensure that the eligibility of enrollees receiving
subsidization of the benefit package is redetermined on an
annual basis.
(7) Monitor, review and evaluate each contractor’s
benefit package for the adequacy, accessibility and
availability of the services required under subsection (h).
(8) Establish and coordinate development, implementation
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and supervision of an outreach plan to ensure that all those
who may be eligible are aware of the program. The outreach
plan shall include provisions for:
(i) Reaching special populations, including nonwhite
and non-English speaking individuals and individuals with
disabilities.
(ii) Reaching different geographic areas, including
rural and inner-city areas.
(iii) Assuring that special efforts are coordinated
within the overall outreach activities throughout this
Commonwealth.
(iv) Allowing for the acceptance of applications at
county assistance offices operated by the Department of
Public Welfare.
(9) Prepare and submit, by March 1, 2010, and annually
thereafter, a report to the chairman and minority chairman of
the Banking and Insurance Committee of the Senate and to the
chairman and minority chairman of the Insurance Committee of
the House of Representatives regarding the number of eligible
adults purchasing coverage under the program with a
geographic distribution, the identity of the contractors, the
scope of the services being provided, the level of outreach,
the cost of the insurance and the amount an eligible adult
contributes toward the insurance, including any copayments
and adjustments to the premiums. The annual report shall be
made available for public inspection and posted on the
department's publicly accessible Internet website.
(10) Undertake efforts as are required to seek receipt
of and qualify for Federal financial participation.
(h) Solicitation.--The department shall solicit bids or <--
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proposals for the program. The solicitation Request for <--
proposals.--In accordance with subsection (g)(2) the department
shall issue a request for proposals for the program. The request
shall require an offeror to assure that if selected as a
contractor it will do all of the following:
(1) Ensure that enrollees and wait-list enrollees have
access to qualified, cost-effective health care providers.
(2) Contract with qualified, cost-effective health care
providers, which shall include primary health care
physicians, certified registered nurse practitioners,
physician assistants, clinical nurse specialists, nurse-
midwives, clinics and health maintenance organizations, to
provide health care for organizations, to provide health care
for enrollees and wait-list enrollees in a manner that best
manages the costs of the services and utilizes other
appropriate medical cost-effective methods and in a manner
consistent with the provider's permitted scope of practice.
(3) Ensure that the individual applying for coverage is
an eligible adult. If a review of the individual's
application for coverage indicates that the individual is not
eligible for adult basic coverage insurance, but may be
eligible for medical assistance, the application for benefits
and all accompanying documentation shall be promptly
transmitted to the appropriate county assistance office for a
determination of eligibility for medical assistance or other
Federal, State and local resources available to the
individual.
(4) Not prohibit enrollment based upon a preexisting
condition nor exclude a diagnosis or treatment for the
condition based on the condition's preexistence.
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(5) Provide an insurance identification card to each
enrollee or wait-list enrollee covered under a contract
executed under this section. The card shall not identify the
enrollee or wait-list enrollee as low income.
(6) Require each provider providing primary care
services under this section to make necessary arrangements
for admission to hospitals and for necessary specialty care.
(7) Not pay any claim on behalf of an enrollee or wait-
list enrollee unless all other Federal, State and local
resources are first utilized and utilize subrogation and
coordination of benefits processes so that the program is the
payor of last resort.
(8) Provide a benefit package to enrollees and wait-list
enrollees consistent with the scope and duration requirements
determined by the department. The Commonwealth may elect to
provide any benefit independently and outside the scope of
any contract entered into with any contractor to provide the
benefit package under the program. The benefit package
determined by the department may include any of the following
services:
(i) Preventive and wellness care.
(ii) Outpatient primary care and specialist
services.
(iii) Inpatient hospitalization.
(iv) Outpatient services.
(v) Emergency care.
(vi) Laboratory and radiology.
(vii) Clinic services.
(viii) Prescription drugs.
(ix) Diabetic medical supplies and equipment.
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(x) Emergency dental care.
(xi) Maternity care.
(xii) Skilled nursing.
(xiii) Home health, palliative and hospice care.
(xiv) Chronic care and disease management.
(xv) Inpatient and outpatient behavioral health
services.
(i) Bids or proposals.--Each professional health service
plan corporation, hospital plan corporation, health maintenance
organization owned or controlled by a professional health
service plan corporation or a hospital plan corporation and each
entity that provides services under the Department of Public
Welfare's Physical Health HealthChoices Program shall be
required to submit a bid or proposal to the department to carry
out the purposes of this chapter. Each professional health
service plan corporation and hospital plan corporation, and
subsidiaries and affiliates doing business in this Commonwealth,
shall submit a bid or proposal to the department to carry out
the purposes of this section in the geographic area serviced by
that entity. Each health maintenance organization owned or
controlled by a health service plan corporation or hospital plan
corporation shall submit a bid or proposal with all eligible
licenses and certificates of authority under its control, in all
service zones in which it is licensed to do business in more
than 50% of the counties in that zone. The service zones shall
be determined by the department in consultation with the
Department of Health and the Department of Public Welfare. Each
entity that provides services under the Physical Health
HealthChoices Program of the Department of Public Welfare shall
submit a bid or proposal in all counties in which it provides
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the services. All other insurers may submit a bid or proposal to
the department to carry out the purposes of this section.
(j) Reviewing, scoring and selecting bids or proposals.--The
department, in consultation with the Department of Public
Welfare, shall review and score bids or proposals on the basis
of all of the requirements for the program. The department may
include other criteria in the solicitation and in the scoring
and selection of the bids or proposals that the department, in
the exercise of its administrative duties under this section and
in consultation with the Department of Public Welfare, deems
necessary. The department shall:
(1) Select, to the greatest extent practicable, offerors
that contract with providers to provide health care services
on a cost-effective basis and that use appropriate cost-
management methods that enable the program to provide
coverage to the maximum number of eligible adults and that,
whenever possible, pursue and utilize available public and
private funds.
(2) Select, to the greatest extent practicable, only
offerors that comply with all procedures relating to
coordination of benefits as required by the department and
the Department of Public Welfare.
(3) Select offerors that limit administrative expenses
to no more than 10% of the amount of the contract. If a
contractor presents documented evidence that administrative
expenses for operational changes from the previous AdultBasic
Program to the program implemented under this act are in
excess of 10% of the amount of the contract, the department
shall make an additional allotment of funds, not to exceed 1%
of the amount of the contract, to the contractor to the
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extent that the department finds the expenses reasonable and
necessary.
(k) Rates and negotiations.--Rates for the program shall be
approved annually by the department and may vary by region and
contractor. Rates shall be based on an actuarially sound and
adequate review. The department may not require a contractor to <--
negotiate a contract with a health care provider that conditions
reimbursements paid to a health care provider at a rate that is
at or below the reimbursement rate paid to a health care
provider under medical assistance. The department shall not
negotiate a contract for a period in excess of four years.
(l) Limitation.--In no case shall the total aggregate amount
of annual contracts entered into pursuant to this section exceed
the amount of the aggregate annual appropriations to the
department for the program.
Section 304. Duties of contractors.
A contractor that contracts with the department to provide a
health benefit plan to eligible adults:
(1) Shall process claims for the coverage.
(2) Shall implement copayment adjustments as soon as
practicable following publication in the Pennsylvania
Bulletin, but in no event more than 120 days following
publication.
(3) May not deny coverage to an eligible adult who has
been approved by the department to participate in the
program.
(4) Shall provide to the department all data, including
individual claims data, as the department determines is
necessary for use in performance measurement and program
improvement.
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(5) Shall fulfill all requirements of any contract
issued to it pursuant to this section.
Section 305. Premiums and charges.
(a) Limitation on fees.--No eligible adult shall be assessed
a fee or other charge, other than those specified in this
chapter, as a requirement for participating in the program.
(b) Premium adjustment.--For each fiscal year beginning
after June 30, 2010, the department may adjust the premium
amounts under section 303(b)(2) to reflect changes in the cost
of medical services and shall forward notice of the new premium
amounts to the Legislative Reference Bureau for publication as a
notice in the Pennsylvania Bulletin.
(c) Copayment adjustment.--For each fiscal year beginning
after June 30, 2010, the department may shall adjust the <--
copayment amounts under section 303(b)(3) to reflect changes in
the cost of medical services and shall forward notice of the new
premium amounts to the Legislative Reference Bureau for
publication as a notice in the Pennsylvania Bulletin.
Section 306. Data matching.
(a) Covered adults.--All entities providing health insurance
or health care coverage within this Commonwealth shall, at least
once every month, provide the names, identifying information and
any additional information on coverage and benefits as the
department may specify for persons for whom the entities provide
insurance or coverage.
(b) Use of information.--The department shall use the
information obtained under subsection (a) to determine whether
another entity has primary liability for health care claims paid
by the program. If a determination is made that the enrollee or
wait-list enrollee has other health care coverage, the
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eligibility of the enrollee or wait-list enrollee shall be
reevaluated, as shall the most cost-effective means of providing
coverage for that enrollee or wait-list enrollee.
Section 307. Information sharing.
Notwithstanding any provision of law to the contrary, the
program and other departments or programs of the Commonwealth
with information relating to the eligibility of individuals for
a Commonwealth program, shall share the information with each
other for purposes of determining and coordinating eligibility
for any State program. Those departments and programs include,
but are not limited to, the Department of Revenue, the
Department of Labor and Industry, the Department of Public
Welfare, the Children's Health Insurance Program and the
program. The information shall be confidential, shall be exempt
from disclosure under the act of February 14, 2008 (P.L.6,
No.3), known as the Right-to-Know Law, and may not be subject to
subpoena and may not be made public by any department or
program, except that it may be disclosed to another Commonwealth
agency or law enforcement official of the Federal or State
government at any time so long as the agency or office receiving
the information agrees in writing to hold it confidential and in
a manner consistent with this act. No individual who receives
information while acting under the authority of this act shall
be permitted or required to testify in a private civil or other
action concerning the information subject to this section.
Section 308. Regulations.
The department may shall promulgate regulations for the <--
implementation and administration of the program. Until final
regulations are adopted, the department shall operate the
program under interim guidelines consistent with this chapter.
20090HB0001PN2098 - 20 -
Section 309. Funding.
(a) Funding contingency for subsidization.--Subsidization of
premiums and copayments paid under subsection (b) is contingent
upon the amount of the funding available to the program and the
Federal poverty levels approved by the Federal waiver or State
plan amendments granted under section 310, and is limited to
eligible adults who are in compliance with the requirements
under this chapter.
(b) Use of funding.--Funding shall be used by the department
to pay the difference between the total monthly cost of the
health benefit plan and the premium payments and copayments by
the eligible adult and for administration and outreach
activities required under subsection 303(f).
Section 310. Federal waivers or State plan amendments.
(a) Application for waivers or amendments.--The Department
of Public Welfare, in cooperation with the department, shall
apply for all applicable waivers from the Federal Government and
shall seek approval to amend the State plan under Title XIX of
the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.)
as necessary to carry out the provisions of this chapter.
(b) Notice of approval.--If the Department of Public Welfare
receives approval of a waiver or approval of a State plan
amendment, it shall notify the department and shall transmit
notice of the waiver or State plan amendment approvals to the
Legislative Reference Bureau for publication as a notice in the
Pennsylvania Bulletin.
(c) Program changes.--The department is authorized to change
the benefits under section 303(h), the premium amounts payable
under section 303(b) and any eligibility requirements under this
chapter in order for the program to meet Federal requirements.
20090HB0001PN2098 - 21 -
Section 311. Federal funds.
Notwithstanding any other provision of law, the Department of
Public Welfare, in cooperation with the department, shall do all
of the following:
(1) Seek the receipt of Federal financial participation
under Title XIX of the Social Security Act (49 Stat. 620, 42
U.S.C. § 1396 et seq.) for coverage and services provided
under this article.
(2) Qualify for available Federal financial
participation under Title XIX of the Social Security Act.
Section 312. Federal programs.
If the Federal Government enacts programs similar to the
program, the program shall be construed to only supplement the
Federal programs; and adults qualified for coverage under the
Federal program shall utilize that Federal program before
utilizing the program.
Section 313. Establishment.
There is established within the State Treasury a special fund
to be known as the Pennsylvania Expanded Adult Basic Coverage
Insurance Program Fund.
Section 314. Deposits into fund and appropriation.
(a) Health Care Provider Retention Account.--On the
effective date of this section, the sum of $362,000,000 shall be
transferred from the Health Care Provider Retention Account to
the Pennsylvania Expanded Adult Basic Coverage Insurance Program
Fund.
(b) Tobacco Settlement Act.--Notwithstanding section
5101(b), funds appropriated under section 306(b)(1)(vi) of the
act of June 26, 2001 (P.L.755, No.77), known as the Tobacco
Settlement Act, for the program established in former Chapter 13
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of that act, shall be deposited into the Pennsylvania Expanded
Adult Basic Coverage Insurance Program Fund.
(c) Premium tax.--Commencing with calendar years beginning
after December 31, 2010, every hospital plan corporation and
professional health service plan corporation operating in this
Commonwealth shall pay the tax on gross premiums payable under
Article IX of the act of March 4, 1971 (P.L.6, No.2), known as
the Tax Reform Code of 1971. The tax payable in calendar year
2011 shall be for gross premiums received in calendar year 2010.
Notwithstanding the provisions of any law to the contrary, the
sums received by the Commonwealth as a result of this tax shall
be deposited into the Pennsylvania Expanded Adult Basic Coverage
Insurance Program Fund. This subsection shall not be effective
if the Agreement on Community Health Reinvestment entered into
February 2, 2005, by the department and Capital BlueCross,
Highmark, Inc., Hospital Service Association of Northeastern
Pennsylvania and Independence Blue Cross and published in the
Pennsylvania Bulletin at 35 Pa.B. 4155 (July 23, 2005) is
extended or otherwise renegotiated to continue, at least, at the
level of Annual Community Health Reinvestment contributed under
that agreement. In that event, the sums received by the
Commonwealth shall be deposited into the Pennsylvania Expanded
Adult Basic Coverage Insurance Program Fund.
(d) Appropriation.--Money in the Pennsylvania Expanded Adult
Basic Coverage Insurance Program Fund is appropriated, upon
approval of the Governor, for health care coverage and services
under this chapter.
Section 315. Certain children of insured parents. <--
(a) General rule.--An insurer that issues, delivers,
executes or renews group health care insurance in this
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Commonwealth, under which coverage of a child would otherwise
terminate at a specified age, shall, at the option of the
policyholder, provide coverage to a child of an insured employee
beyond that specified age, up through and including the age of
29, at the insured employee's expense, and provided that the
child meet all of the following requirements:
(1) Is not married.
(2) Has no dependents.
(3) Is a resident of this Commonwealth or is enrolled as
a full-time student at an institution of higher education.
(4) Is not provided coverage as a named subscriber,
insured, enrollee or covered person under any other group or
individual health insurance policy or enrolled in or entitled
to benefits under any government health care benefits
program, including benefits under Title XVIII of the Social
Security Act (49 Stat. 620, 42 U.S.C. § 1395 et seq.).
(b) Increase in premium.--Insurers may determine increases
in premiums related to continuation of coverage for the adult
dependent past the limiting age of 19.
(c) Exclusions.--This section shall not include the
following types of insurance or any combination thereof:
(1) Hospital indemnity.
(2) Accident.
(3) Specified disease.
(4) Disability income.
(5) Dental.
(6) Vision.
(7) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(8) Medicare supplement.
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(9) Long-term care.
(10) Other limited benefit plans.
(11) Individual health insurance policies.
(d) Definitions.--As used in this section, the following
words and phrases shall have the meanings given to them in this
subsection:
"Health care insurance" A group health, sickness or accident
policy or subscriber contract or certificate issued by an entity
subject to any one of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as 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) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
CHAPTER 5
PHYSICIAN RETENTION LOAN FORGIVENESS
Section 501. Purpose.
The purpose of this chapter is to improve patient access to
health care by assisting the Commonwealth with recruitment and
retention of physicians.
Section 502. 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:
"Agency." The Pennsylvania Higher Education Assistance
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Agency.
"Health care facility." As defined in section 103 of the act
of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Physician." A medical doctor or doctor of osteopathy.
"Program." The Physician Retention Loan Forgiveness Program
established by this chapter.
Section 503. Program.
(a) Establishment.--The Physician Retention Loan Forgiveness
Program is established in the agency.
(b) Applications.--The agency shall promulgate guidelines
for the selection of candidates to the program based upon the
following criteria:
(1) Demonstrated need.
(2) Willingness to continue practicing as a physician in
this Commonwealth after completing the program.
(c) Eligibility.--A program applicant must be:
(1) A citizen of the United States.
(2) Licensed to practice medicine in this Commonwealth
and specializing in one of the following:
(i) Internal medicine.
(ii) Family medicine.
(iii) Pediatrics.
(iv) Obstetrics and gynecology.
(d) Selection.--The agency shall give preference to
physicians in the following order:
(1) Recipients of loans who by contract with the agency
agree to practice medicine in an area of this Commonwealth
that is reported by the Department of Health as medically
underserved or in a primary care health professional shortage
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area.
(2) Commonwealth physicians completing training in this
Commonwealth.
(3) Out-of-State applicants completing training in this
Commonwealth.
(4) Commonwealth natives completing out-of-State
training.
(5) Out-of-State candidates completing out-of-State
training.
(e) Verification.--The agency shall monitor and verify a
physician's fulfillment of all requirements under this chapter.
Section 504. Amount of loan forgiveness.
(a) Physicians practicing full time.--A physician accepted
into the program practicing full time may be reimbursed an
amount up to 100% of the total loan for physician training based
upon the following repayment assistance schedule:
(1) First year of service, 10%.
(2) Second year of service, 10%.
(3) Third year of service, 10%.
(4) Fourth year of service, 10%.
(5) Fifth year of service, 10%.
(6) Sixth year of service, 10%.
(7) Seventh year of service, 10%.
(8) Eighth year of service, 10%.
(9) Ninth year of service, 10%.
(10) Tenth year of service, 10%.
(b) Physicians practicing part time.--A physician accepted
into the program practicing part time may be reimbursed an
amount directly proportional to the number of hours worked of
the total loan for physician training based upon the following
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repayment assistance schedule:
(1) First year of service, 10%.
(2) Second year of service, 10%.
(3) Third year of service, 10%.
(4) Fourth year of service, 10%.
(5) Fifth year of service, 10%.
(6) Sixth year of service, 10%.
(7) Seventh year of service, 10%.
(8) Eighth year of service, 10%.
(9) Ninth year of service, 10%.
(10) Tenth year of service, 10%.
Section 505. Contract.
(a) General rule.--Physicians receiving loan forgiveness
shall enter into a contract with the agency. The contract shall
include, but not be limited to, the following terms and
conditions:
(1) The physician shall agree to practice not fewer than
ten full consecutive years in a licensed health care facility
in this Commonwealth immediately following completion of
training pursuant to the schedule provided in section 5.
(2) The physician shall agree to accept Medicare and
Medicaid patients.
(3) The physician shall agree not to discriminate
against patients based on the ability to pay.
(4) The physician shall permit the agency to monitor
compliance with the work requirement.
(5) The agency shall certify compliance of the physician
receiving a loan forgiveness award for years subsequent to
the initial year of the loan.
(6) The contract shall be renewable on an annual basis
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upon certification by the agency that the physician has
complied with the terms of the contract.
(7) The contract shall terminate if the physician dies,
is not able to perform the duties of a physician or is not
able to maintain the physician's license to practice medicine
due to physical or mental disability.
(8) If the physician's license to practice is suspended
or revoked, the agency shall have the authority to terminate
the physician's participation in the program and require
repayment of all loan forgiveness payments rendered to date.
(9) A physician who fails to begin or complete the
obligations contracted for shall reimburse the Commonwealth
all amounts received under this chapter and interest thereon
as determined by the agency. Both the physician and the
agency shall make every effort to resolve conflicts in order
to prevent a breach of contract.
(b) Contract enforcement.--The agency shall have the
authority to seek garnishment of wages for the collection of
damages provided for in subsection (a)(9).
Section 506. Disqualification.
Any person who knowingly or intentionally procures, obtains
or aids another to procure or obtain loan forgiveness under this
chapter through fraudulent means shall be disqualified from
participation and shall be liable to the agency for an amount
equal to three times the amount obtained.
Section 507. Tax consequences.
Loan forgiveness payments received by a physician shall not
be considered taxable income for purposes of Article III of the
act of March 4, 1971 (P.L.6, No.2), known as the Tax Reform Code
of 1971.
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Section 508. Regulations.
The agency shall adopt regulations and procedures necessary
to carry out the purposes of this chapter.
Section 509. Funding.
Loan forgiveness payments shall be made from the Health Care
Provider Retention Account.
CHAPTER 7
TELEHEALTH
Section 701. 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:
"Health care professional." An individual who is licensed,
certified or otherwise regulated to provide health care services
under the laws of this Commonwealth.
"Health care services." Services for the diagnosis,
prevention, treatment, cure or relief of a health condition,
injury, disease or illness.
"Telehealth." The remote interaction between a health care
professional and a patient through the use of any of the
following:
(1) A video camera transmission.
(2) A computer video transmission.
(3) An electronic health monitoring device.
(4) Another telecommunications device that delivers
health information concerning a patient to a health care
professional.
Section 702. Provision of coverage.
An insurer that issues, delivers, executes or renews health
care insurance in this Commonwealth shall provide coverage for
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telehealth if a health care professional certifies all of the
following:
(1) That the use of telehealth is appropriate for the
patient.
(2) That the health care professional will be able to
maintain proper direct examination of the patient or that
direct examination of the patient is not necessary.
(3) That the use of telehealth will result in lower
health care costs than if it were not used.
CHAPTER 41
HOSPITAL ELECTRONIC INFORMATION INCENTIVE PAYMENT PROGRAM
Section 4101. Scope of chapter.
This chapter establishes the Hospital Electronic Information
Incentive Payment Program.
Section 4102. 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:
"Department." The Department of Public Welfare of the
Commonwealth.
"Eligible hospital." An acute care hospital or critical
access hospital which is a meaningful electronic health record
user as defined under section 4102 of the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5, 123 Stat. 115).
Section 4103. Hospital Electronic Information Incentive Payment
Program.
(a) Establishment.--There is established within the
department a program to be known as the Hospital Electronic
Information Incentive Payment Program. The program shall provide
financial assistance to certain acute care hospitals and
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critical access hospitals for the implementation of electronic
health record systems.
(b) Application.--The department shall establish a payment
incentive program consistent with the provisions of section 4102
of the American Recovery and Reinvestment Act of 2009 (Public
Law 111-5, 123 Stat. 115) to provide assistance to eligible
hospitals for the implementation of electronic health record
systems.
CHAPTER 43
DENTISTS FOR MEDICAL
ASSISTANCE PATIENTS
Section 4301. Scope of chapter.
This chapter relates to dentists for medical assistance
patients.
Section 4302. Purpose.
The purpose of this chapter is to help meet the inadequacies
for improving care to those on medical assistance, to bring
dentists into communities where there is a need and to provide
an incentive to students of this Commonwealth to pursue higher
education and training in dentistry in order to maintain the
quality of health care services in this Commonwealth.
Section 4303. 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:
"Dentist." A doctor of dental surgery or doctor of dental
medicine who is licensed within this Commonwealth to practice
dentistry.
"Department." The Department of Public Welfare of the
Commonwealth.
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"Program." The Dentists for Medical Assistance Patients
Program established under this chapter.
Section 4304. Program.
(a) Establishment.--The Dentists for Medical Assistance
Patients Program is established within the department.
(b) Administration.--The Commonwealth shall administer the
program on a Statewide basis and utilize funds in the program to
encourage recently graduated dentists to provide care to
patients on medical assistance in each of the counties based on
need. The Commonwealth shall provide an annual supplemental
salary of $80,000 to recently graduated dentists within three
years from the date of graduation who dedicate 50% of their
practice to caring for patients on medical assistance. Dentists
within six years from the date of graduation shall receive an
annual supplemental salary of $30,000 if they dedicate 20% of
their practice to serving patients on medical assistance.
(c) Applications.--The department shall promulgate
guidelines for the selection of candidates to the program based
on the following criteria:
(1) Demonstrated need.
(2) Willingness to continue practicing and serving
patients on medical assistance in this Commonwealth after
expiration of the program.
(d) Eligibility.--Dentists must be within three years from
the date of graduation from an accredited dental school to
receive an annual supplemental salary of $80,000 or within six
years from the date of graduation from an accredited dental
school to receive an annual supplemental salary of $30,000 from
the Commonwealth. Participating dentists shall not be eligible
to receive reimbursements from the Commonwealth for serving
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patients on medical assistance beyond this program.
(e) Selection.--The department shall give preference to
dentists in the following order:
(1) Recipients of funds who, by contract with the
department, agree to practice dentistry in an area of this
Commonwealth that is reported by the department as an area
where a shortage of dentists who serve patients on medical
assistance exists.
(2) Commonwealth natives completing training in this
Commonwealth.
(3) Out-of-State candidates completing training in this
Commonwealth.
(4) Commonwealth natives completing out-of-State
training.
(5) Out-of-State candidates completing out-of-State
training.
(f) Verification.--The department shall monitor and verify a
dentist's fulfillment of all requirements under this chapter.
Section 4305. Contract.
(a) General rule.--Dentists receiving funds shall enter into
a contract with the department. The contract shall include, but
not be limited to, the following terms and conditions:
(1) The dentist shall agree to provide care to the
established percentage of patients on medical assistance in
relation to the total number of patients served.
(2) The dentist shall permit the department to monitor
compliance with the percentage requirement.
(3) The contract shall be renewable on an annual basis
upon certification by the department that the dentist has
complied with the terms of the contract. Contracts may be
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renewable for a total of six years.
(4) The contract shall terminate if the dentist dies, is
not able to perform the duties of a dentist or is not able to
maintain the dentist's license to practice dentistry due to
physical or mental disability.
(5) If a dentist's license to practice is suspended or
revoked, the department shall have the authority to terminate
the dentist's participation in the program and demand
repayment of all funds rendered to date.
(6) A dentist who fails to begin or complete the
obligations contracted for shall reimburse the Commonwealth
all amounts received under this chapter and interest thereon
as determined by the department. Both the dentist and the
department shall make every effort to resolve conflicts in
order to prevent a breach of contract.
(b) Contract enforcement.--The department shall have the
authority to seek garnishment of wages for the collection of
damages provided for under subsection (a)(6).
Section 4306. Funding.
The department is authorized to use funds specifically
appropriated by the General Assembly and any funds,
contributions or payments which may be available to the
department by another Commonwealth agency, the Federal
Government or any public or private source for the purpose of
implementing this section.
Section 4307. Reporting requirements.
The department shall submit annually to the chairman and
minority chairman of the Public Health and Welfare Committee of
the Senate and the chairman and minority chairman of the Health
and Human Services Committee of the House of Representatives a
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report that provides details of the department's expenditures,
including administrative expenditures, under this section.
Section 4308. Regulations.
The department shall adopt rules and regulations to carry out
the provisions of this chapter.
CHAPTER 51
MISCELLANEOUS PROVISIONS
Section 5101. Repeals.
(a) Declaration of policy.--The General Assembly declares
that the repeal under subsection (b) is necessary to effectuate
this act.
(b) Specific.--Chapter 13 of the act of June 26, 2001
(P.L.755, No.77), known as the Tobacco Settlement Act, is
repealed.
(c) Inconsistent.--All acts and parts of acts are repealed
insofar as they are inconsistent with this act.
Section 5102. Effective date.
This act shall take effect in 90 days.
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