PRINTER'S NO. 2834
No. 2122 Session of 2001
INTRODUCED BY BROWNE, ARGALL, BELARDI, BENNINGHOFF, CAPPELLI,
CLARK, L. I. COHEN, CURRY, DAILEY, DALLY, DeLUCA, FORCIER,
FRANKEL, FREEMAN, GEIST, GEORGE, GRUCELA, HARHART, HENNESSEY,
HERMAN, HORSEY, HUTCHINSON, JAMES, MANDERINO, MANN, McCALL,
McILHATTAN, MELIO, S. MILLER, NAILOR, PIPPY, ROSS, SAMUELSON,
SATHER, SCHRODER, SHANER, SOLOBAY, STABACK, STEELMAN,
E. Z. TAYLOR, THOMAS, TIGUE, TRICH, WALKO, WASHINGTON,
WATERS, WATSON, C. WILLIAMS, WILT, WOJNAROSKI, YOUNGBLOOD,
YUDICHAK AND ZUG, NOVEMBER 13, 2001
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
NOVEMBER 13, 2001
AN ACT
1 Amending the act of July 8, 1986 (P.L.408, No.89), entitled, as
2 reenacted and amended, "An act providing for the creation of
3 the Health Care Cost Containment Council, for its powers and
4 duties, for health care cost containment through the
5 collection and dissemination of data, for public
6 accountability of health care costs and for health care for
7 the indigent; and making an appropriation," further providing
8 for data submission and collection and for data dissemination
9 and publication; providing for fees; and establishing the
10 Health Maintenance Organization Reports Restricted Account.
11 The General Assembly of the Commonwealth of Pennsylvania
12 hereby enacts as follows:
13 Section 1. Section 3 of the act of July 8, 1986 (P.L.408,
14 No.89), known as the Health Care Cost Containment Act, reenacted
15 and amended June 28, 1993 (P.L.146, No.34), is amended by adding
16 a definition to read:
17 Section 3. Definitions.
18 The following words and phrases when used in this act shall
1 have the meanings given to them in this section unless the
2 context clearly indicates otherwise:
3 * * *
4 "Enrollee." A policyholder, subscriber, covered person or
5 other individual who is entitled to receive health care services
6 under an HMO plan.
7 * * *
8 Section 2. Sections 4(b) and 6(d) of the act are amended to
9 read:
10 Section 4. Health Care Cost Containment Council.
11 * * *
12 (b) Composition.--The council shall consist of 21 voting
13 members, composed of and appointed in accordance with the
14 following:
15 (1) The Secretary of Health.
16 (1.1) The Physician General.
17 (2) The Secretary of Public Welfare.
18 (3) The Insurance Commissioner.
19 (4) [Six] Four representatives of the business
20 community, at least one of whom represents small business,
21 who are purchasers of health care as defined in section 3,
22 none of which is primarily involved in the provision of
23 health care or health insurance, [three] two of which shall
24 be appointed by the President pro tempore of the Senate and
25 [three] two of which shall be appointed by the Speaker of the
26 House of Representatives from a list of twelve qualified
27 persons recommended by the Pennsylvania Chamber of Business
28 and Industry. Three nominees shall be representatives of
29 small business.
30 (5) [Six] Four representatives of organized labor,
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1 [three] two of which shall be appointed by the President pro
2 tempore of the Senate and [three] two of which shall be
3 appointed by the Speaker of the House of Representatives from
4 a list of twelve qualified persons recommended by the
5 Pennsylvania AFL-CIO.
6 (6) [One representative of consumers who is] Four
7 representatives of consumers who are not primarily involved
8 in the provision of health care or health care insurance,
9 appointed by the Governor from a list of [three] six
10 qualified persons recommended jointly by the [Speaker]
11 Majority Leader and Minority Leader of the House of
12 Representatives and the [President pro tempore] Majority
13 Leader and Minority Leader of the Senate.
14 (7) One representative of hospitals, appointed by the
15 Governor from a list of three qualified hospital
16 representatives recommended by the Hospital Association of
17 Pennsylvania. The representative under this paragraph may
18 appoint two additional delegates to act for the
19 representative only at meetings of committees, as provided
20 for in subsection (f).
21 (8) One representative of physicians, appointed by the
22 Governor from a list of three qualified physician
23 representatives recommended jointly by the Pennsylvania
24 Medical Society and the Pennsylvania Osteopathic Medical
25 Society. The representative under this paragraph may appoint
26 two additional delegates to act for the representative only
27 at meetings of committees, as provided for in subsection (f).
28 (9) One representative of the Blue Cross and Blue Shield
29 plans in Pennsylvania, appointed by the Governor from a list
30 of three qualified persons recommended jointly by the Blue
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1 Cross and Blue Shield plans of Pennsylvania.
2 (10) One representative of commercial insurance
3 carriers, appointed by the Governor from a list of three
4 qualified persons recommended by the Insurance Federation of
5 Pennsylvania, Inc.
6 (11) One representative of health maintenance
7 organizations, appointed by the Governor from a list of three
8 qualified persons recommended by the Pennsylvania Association
9 of Health Maintenance Organizations.
10 (12) In the case of each appointment to be made from a
11 list supplied by a specified organization, it is incumbent
12 upon that organization to consult with and provide a list
13 which reflects the input of other equivalent organizations
14 representing similar interests. Each appointing authority
15 will have the discretion to request additions to the list
16 originally submitted. Additional names will be provided not
17 later than 15 days after such request. Appointments shall be
18 made by the appointing authority no later than 90 days after
19 receipt of the original list. If, for any reason, any
20 specified organization supplying a list should cease to
21 exist, then the respective appointing authority shall specify
22 a new equivalent organization to fulfill the responsibilities
23 of this act.
24 * * *
25 Section 6. Data submission and collection.
26 * * *
27 (d) [Provider quality] Quality and [provider] service
28 effectiveness data elements.--
29 (1) In carrying out its duty to collect data on provider
30 quality and provider service effectiveness under section
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1 5(d)(4) and subsection (c)(21), the council shall define a
2 methodology to measure provider service effectiveness which
3 may include additional data elements to be specified by the
4 council sufficient to carry out its responsibilities under
5 section 5(d)(4). The council may adopt a nationally
6 recognized methodology of quantifying and collecting data on
7 provider quality and provider service effectiveness until
8 such time as the council has the capability of developing its
9 own methodology and standard data elements. The council shall
10 include in the Pennsylvania Uniform Claims and Billing Form a
11 field consisting of the data elements required pursuant to
12 subsection (c)(21) to provide information on each provision
13 of covered services sufficient to permit analysis of provider
14 quality and provider service effectiveness within 180 days of
15 commencement of its operations pursuant to section 4.
16 (2) In order to comparably measure performance of health
17 maintenance organizations, the council has the following
18 powers and duties:
19 (i) To adopt and implement a system to comparatively
20 evaluate the quality of care outcomes and performance
21 measurements of health maintenance organizations on an
22 objective basis. This subparagraph includes, but is not
23 limited to, surveying enrollee satisfaction and assessing
24 health maintenance organizations' clinical and service
25 performance for:
26 (A) information and communication;
27 (B) treatment;
28 (C) preventive care;
29 (D) services for individuals with special needs;
30 (E) referrals; and
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1 (F) options available to patients.
2 (ii) In carrying out its responsibilities, the
3 council shall not require health maintenance
4 organizations to report on additional data elements that
5 are not reported to nationally recognized accrediting
6 organizations or to the Department of Health or the
7 Insurance Department in quarterly or annual reports.
8 Furthermore, the council shall not require reporting by
9 HMOs in different formats than are required for reporting
10 to nationally recognized accrediting organizations or on
11 quarterly or annual reports submitted to the Department
12 of Health or the Insurance Department as required by
13 regulations of either department. The council may adopt
14 the quality findings as reported to nationally recognized
15 accrediting organizations.
16 * * *
17 Section 3. Section 7(a) of the act is amended by adding a
18 paragraph to read:
19 Section 7. Data dissemination and publication.
20 (a) Public reports.--Subject to the restrictions on access
21 to council data set forth in section 10 and utilizing the data
22 collected under section 6 as well as other data, records and
23 matters of record available to it, the council shall prepare and
24 issue reports to the General Assembly and to the general public,
25 according to the following provisions:
26 * * *
27 (5) (i) The council shall, for every health maintenance
28 organization in this Commonwealth, prepare and issue an
29 annual report to assist consumers, purchasers and
30 providers with a comparison of health plan performance.
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1 The council shall coordinate its work with existing
2 health plan performance measurement efforts developed by
3 other State agencies or nationally recognized accrediting
4 organizations. The annual report shall include, but is
5 not limited to, information in the following areas:
6 (A) Availability and appropriateness of services
7 and treatment provided to enrollees.
8 (B) Availability and appropriateness of
9 preventive care provided to enrollees.
10 (C) Availability and appropriateness of services
11 provided to enrollees with ongoing and/or severe
12 medical needs as well as those with special needs.
13 (D) Enrollee satisfaction, including access to
14 specialty care and services, satisfaction with
15 network adequacy and health plan materials.
16 (E) Licensure and accreditation status.
17 (ii) The council shall ensure that HMOs have an
18 opportunity to review the annual report at least 45 days
19 prior to public release.
20 * * *
21 Section 4. This act shall take effect in 180 days.
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