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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY DeLUCA, KOTIK, MANDERINO, WALKO, FRANKEL, BELFANTI, BRENNAN, CALTAGIRONE, GIBBONS, GROVE, HARKINS, MANN, McILVAINE SMITH, MILLER, MUNDY, READSHAW, SIPTROTH, SOLOBAY, STABACK, VULAKOVICH, WHITE AND WANSACZ, JANUARY 28, 2009 |
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| REFERRED TO COMMITTEE ON INSURANCE, JANUARY 28, 2009 |
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| AN ACT |
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1 | Establishing a system for payment or reduction in payment for |
2 | preventable serious adverse events within this Commonwealth; |
3 | and providing for the powers and duties of the Department of |
4 | Health and the Department of State. |
5 | The General Assembly of the Commonwealth of Pennsylvania |
6 | hereby enacts as follows: |
7 | Section 1. Short title. |
8 | This act shall be known and may be cited as the Preventable |
9 | Serious Adverse Events Act. |
10 | Section 2. Definitions. |
11 | The following words and phrases when used in this act shall |
12 | have the meanings given to them in this section unless the |
13 | context clearly indicates otherwise: |
14 | "Health care facility." A health care facility as defined |
15 | under section 802.1 of the act of July 19, 1979 (P.L.130, No. |
16 | 48), known as the Health Care Facilities Act, or an entity |
17 | licensed as a hospital under the act of June 13, 1967 (P.L.31, |
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1 | No.21), known as the Public Welfare Code. |
2 | "Health care provider." A health care facility or a person, |
3 | including a corporation, university or other educational |
4 | institution, licensed or approved by the Commonwealth to provide |
5 | health care or professional medical services. The term shall |
6 | include, but not be limited to, a physician, a certified nurse |
7 | midwife, a podiatrist, a certified registered nurse |
8 | practitioner, a physician assistant, a chiropractor, a hospital, |
9 | an ambulatory surgery center, a nursing home or a birth center. |
10 | "Health payor." An individual or entity paying for health |
11 | services for himself or itself or on behalf of another. |
12 | "Medical assistance." The Commonwealth's medical assistance |
13 | program established under the act of June 13, 1967 (P.L.31, No. |
14 | 21), known as the Public Welfare Code. |
15 | "National Quality Forum." A not-for-profit membership |
16 | organization created to develop and implement a national |
17 | strategy for health care quality measurement and reporting. |
18 | "Preventable serious adverse event." An event that occurs in |
19 | a health care facility that is within the health care provider's |
20 | control to avoid, but that occurs because of an error or other |
21 | system failure and results in a patient's death, loss of body |
22 | part, disfigurement, disability or loss of bodily function |
23 | lasting more than seven days or still present at the time of |
24 | discharge from a health care facility. Such events shall be |
25 | within the list of reportable serious events adopted by the |
26 | National Quality Forum. |
27 | Section 3. Payment policy for preventable serious adverse |
28 | events. |
29 | (a) General rule.--Health care providers may not knowingly |
30 | seek payment from health payors, or patients for a preventable |
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1 | serious adverse event or services required to correct or treat |
2 | the problem created by such an event when such an event occurred |
3 | under their control. |
4 | (b) Refunds.--A health care provider who discovers that |
5 | payment has unknowingly been sought for a preventable serious |
6 | adverse event or services required to correct or treat the |
7 | problem created by such an event shall immediately notify the |
8 | health payor, or patient and shall refund any payment received |
9 | within 30 days of discovery or receipt of payment, whichever is |
10 | later. |
11 | (c) Notification.--A health care payor who discovers that |
12 | payment has been sought for a preventable serious adverse event |
13 | or services required to correct or treat a problem created by |
14 | such an event shall notify the health care provider that payment |
15 | may not be sought for such an event or services and that payment |
16 | shall not be made for such events or services. |
17 | (d) Liability.--Any information provided to any health care |
18 | payor or health care provider, in compliance with subsections |
19 | (b) and (c), shall not be discoverable or admissible in any |
20 | civil or administrative action related to the act of March 20, |
21 | 2002 (P.L.154, No.13), known as the Medical Care Availability |
22 | and Reduction of Error (Mcare) Act. |
23 | Section 4. Duties of Department of Health. |
24 | (a) Publishing of updates.--The department shall publish in |
25 | the Pennsylvania Bulletin any updates to the list of reportable |
26 | serious adverse events adopted by the National Quality Forum |
27 | within 30 days of the update issued by the National Quality |
28 | Forum. |
29 | (b) Health department responsibility.--In accordance with |
30 | the act of July 19, 1979 (P.L.130, No.48), known as the Health |
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1 | Care Facilities Act, the Department of Health shall be |
2 | responsible for investigating patient complaints regarding a |
3 | health care facility that is seeking payment directly from the |
4 | patient or health care payor for a preventable serious adverse |
5 | event. |
6 | Section 5. Duties of Department of State. |
7 | The Department of State shall be responsible for |
8 | investigating patient complaints regarding a health care |
9 | provider that is not a health care facility that is seeking or |
10 | causing to be sought payment directly from the patient or health |
11 | care payor for a preventable serious adverse event. |
12 | Section 6. Applicability. |
13 | (a) Hospital medical assistance payment policy.--Nothing in |
14 | this act shall require the Department of Public Welfare to |
15 | alter, amend or reissue any payment policy for inpatient |
16 | hospitals relating to preventable serious adverse events that |
17 | was promulgated prior to the enactment of this act. Any |
18 | modifications to the Department of Public Welfare payment policy |
19 | promulgated on or after the date of enactment of this act for a |
20 | health care provider for a preventable serious adverse event |
21 | shall require a 30-day public comment period. |
22 | (b) Contracts.--Nothing in this act shall prohibit a health |
23 | care provider and payor from establishing by contract any |
24 | policies and procedures associated with serious preventable |
25 | adverse events necessary to implement the provisions of this |
26 | act. |
27 | (c) Reporting.-- |
28 | (1) Health care providers shall include all applicable |
29 | medical codes in making reports in compliance with the act of |
30 | July 8, 1986 (P.L.408, No.89), known as the Health Care Cost |
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1 | Containment Act. |
2 | (2) A preventable serious adverse event shall be |
3 | reported pursuant to the requirements of the act of March 20, |
4 | 2002 (P.L.154, No.13), known as the Medical Care Availability |
5 | and Reduction of Error (Mcare) Act. |
6 | (d) Medicare payment.--Nothing in this act shall be |
7 | construed to supersede Medicare payment policies where the |
8 | services provided to the patient are paid for by Medicare. If |
9 | Medicare denies payment based on a determination that a |
10 | preventable serious adverse event has occurred, nothing in this |
11 | act shall be construed to require medical assistance or a health |
12 | payor to pay a claim for the event or services. |
13 | Section 7. Effective date. |
14 | This act shall take effect in 180 days. |
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