THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY KASUNIC, BOSCOLA, FARNESE, FONTANA, HUGHES, KITCHEN, LOGAN, MUSTO, STOUT, WASHINGTON AND WILLIAMS, MAY 27, 2009

REFERRED TO BANKING AND INSURANCE, MAY 27, 2009  

AN ACT

Amending the act of April 9, 1929 (P.L.177, No.175), entitled

"An act providing for and reorganizing the conduct of the

executive and administrative work of the Commonwealth by the

Executive Department thereof and the administrative

departments, boards, commissions, and officers thereof,

including the boards of trustees of State Normal Schools, or

Teachers Colleges; abolishing, creating, reorganizing or

authorizing the reorganization of certain administrative

departments, boards, and commissions; defining the powers and

duties of the Governor and other executive and administrative

officers, and of the several administrative departments,

boards, commissions, and officers; fixing the salaries of the

Governor, Lieutenant Governor, and certain other executive

and administrative officers; providing for the appointment of

certain administrative officers, and of all deputies and

other assistants and employes in certain departments, boards,

and commissions; and prescribing the manner in which the

number and compensation of the deputies and all other

assistants and employes of certain departments, boards and

commissions shall be determined," establishing the Office of

Health Maintenance Organization Consumer Advocate as an

independent office within the Office of Attorney General and

prescribing its powers and duties.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  The act of April 9, 1929 (P.L.177, No.175), known

as The Administrative Code of 1929, is amended by adding an

article to read:

ARTICLE IX-C

OFFICE OF HEALTH MAINTENANCE ORGANIZATION CONSUMER

ADVOCATE

Section 901-C.  Definitions.

The following words and phrases when used in this article

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Consumer."  A person who meets either of the following

criteria:

(1)  Makes direct use of or is the ultimate recipient of

a product or service supplied by a health maintenance

organization.

(2)  May be a direct user or ultimate recipient of a

product or service supplied by a person or health maintenance

organization and may be affected in any way by any action by

a health maintenance organization.

"Department."  The Insurance Department of the Commonwealth

and includes the Insurance Commissioner.

"Health maintenance organization" or "HMO."  An organized

system which combines the delivery and financing of health care

and provides basic health services to voluntarily enrolled

subscribers for a fixed prepaid fee.

Section 902-C.  Office of Health Maintenance Organization

Consumer Advocate.

(a)  Establishment.--The Office of Health Maintenance

Organization Consumer Advocate is established as an independent

office within the Office of Attorney General to represent the

interest of consumers before the department.

(b)  Administration.--The Office of HMO Consumer Advocate

shall be headed by the HMO Consumer Advocate who shall be

appointed by the Attorney General and by reason of training,

experience and attainment shall be qualified to represent the

interest of consumers. The Executive Board shall set the

compensation of the HMO Consumer Advocate.

(c)  Conflict of interest.--No individual who serves as HMO

Consumer Advocate shall, while serving in the position, engage

in any business, vocation or other employment, or have other

interests, inconsistent with the official responsibilities, nor

shall the individual seek or accept employment nor render

beneficial services for compensation with any health maintenance

organization subject to the authority of the office during the

tenure of the appointment and for a period of two years

immediately after the appointment is served or terminated.

(d)  Restriction.--No individual who is appointed as HMO

Consumer Advocate shall seek election nor accept appointment to

any political office during the tenure as HMO Consumer Advocate

and for a period of two years after the appointment is served or

terminated.

Section 903-C.  Assistant consumer advocates and employees.

The HMO Consumer Advocate shall appoint attorneys as

assistant HMO consumer advocates and additional clerical,

technical and professional staff as may be appropriate, and may

contract for additional services as shall be necessary for the

performance of the duties imposed by this article. The Executive

Board shall set the compensation of assistant HMO consumer

advocates and clerical, technical and professional staff. No

assistant HMO consumer advocate or other staff employee shall,

while serving in the position, engage in any business, vocation

or other employment or have other interests inconsistent with

official responsibilities.

Section 904-C.  Powers and duties of the HMO Consumer Advocate.

(a)  General rule.--In addition to any other authority

conferred by this article, the HMO Consumer Advocate shall, in

carrying out the responsibilities under this article, represent

the interest of consumers as a party, or otherwise participate

for the purpose of representing an interest of consumers before

the department in any matter properly before the department, and

before any court or agency, initiating proceedings if, in the

judgment of the HMO Consumer Advocate, the representation may be

necessary, in connection with any matter involving regulation by

the department or the corresponding regulatory agency of the

Federal Government, whether on appeal or otherwise initiated.

(b)  Monitoring.--The HMO Consumer Advocate may monitor all

cases before departments of the United States, including, but

not limited to, the Department of Health and Human Services,

which impact the interests of consumers in this Commonwealth and

may formally participate in those proceedings which in his

judgment warrant participation.

(c)  Exercise of discretion.--The HMO Consumer Advocate may

exercise discretion in determining the interests of consumers

which will be advocated in any particular proceeding and in

determining whether or not to participate in or initiate any

particular proceeding and, in so determining, shall consider the

public interest, the resources available and the substantiality

of the effect of the proceeding on the interest of consumers.

The HMO Consumer Advocate may refrain from intervening when, in

the judgment of the HMO Consumer Advocate, intervention is not

necessary to represent adequately the interest of consumers.

(d)  Other duties.--In addition to any other authority

conferred by this article, the HMO Consumer Advocate shall

represent an interest of consumers which is presented for

consideration, upon petition in writing, by a substantial number

of persons who are consumers. The HMO Consumer Advocate shall

notify the principal sponsors of the petition within a

reasonable time after receipt of the petition of the action

taken or intended to be taken with respect to the interest of

consumers presented in that petition. If the HMO Consumer

Advocate declines or is unable to represent the interest,

written notification and the reasons for the action shall be

given to the sponsors.

(e)  Action.--Any action brought by the HMO Consumer Advocate

before a court or an agency of this Commonwealth shall be

brought in the name of the HMO Consumer Advocate. The HMO

Consumer Advocate may name a consumer or group of consumers in

whose name the action may be brought or may join with a consumer

or group of consumers in bringing the action.

(f)  Public statement.--At a time as the HMO Consumer

Advocate determines, in accordance with applicable time

limitations to initiate, intervene or otherwise participate in

any department, agency or court proceeding, the HMO Consumer

Advocate shall issue publicly a written statement, a copy of

which shall be filed in the proceeding in addition to any

required entry of appearance, stating concisely the specific

interest of consumers to be protected.

Section 905-C.  Duties of department.

In dealing with any proposed action which may substantially

affect the interest of consumers, the department shall:

(1)  Notify the HMO Consumer Advocate when notice of the

proposed action is given to the public or at a time fixed by

agreement between the HMO Consumer Advocate and the

department in a manner to assure the HMO Consumer Advocate

reasonable notice and adequate time to determine whether to

intervene in the matter.

(2)  Consistent with its other statutory

responsibilities, take action with due consideration to the

interest of consumers.

Section 906-C.  Reports.

The HMO Consumer Advocate shall transmit to the Governor, the

Attorney General and the General Assembly, and shall make

available to the public, an annual report on the conduct of the

Office of HMO Consumer Advocate. The HMO Consumer Advocate shall

make recommendations as may, from time to time, be necessary or

desirable to protect the interest of consumers.

Section 907-C.  Savings provision and construction.

Nothing contained in this article shall in any way be

construed:

(1)  to limit the right of a consumer to bring a

proceeding before either the department or a court; or

(2)  to impair the statutory authority or responsibility

of the department to regulate health maintenance

organizations in the public interest.

Section 2.  This act shall take effect in 60 days.