PRINTER'S NO. 1532
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1102
Session of
2015
INTRODUCED BY DINNIMAN, COSTA, BREWSTER, VULAKOVICH AND HAYWOOD,
JANUARY 28, 2016
REFERRED TO PUBLIC HEALTH AND WELFARE, JANUARY 28, 2016
AN ACT
Providing immunity for providers of free or low-cost health
care.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Access to
Health Care Act.
Section 2. Legislative findings.
The General Assembly finds and declares as follows:
(1) A significant proportion of the residents of this
Commonwealth who are uninsured or Medicaid recipients are
unable to access needed health care because health care
providers fear the increased risk of medical negligence
liability.
(2) It is the intent of the General Assembly:
(i) That access to medical care for indigent
residents be improved by providing governmental
protection to health care providers who offer free or low
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cost quality medical services to underserved populations
of the Commonwealth.
(ii) To ensure that health care professionals who
contract to provide such services as agents of the State
are provided governmental immunity.
Section 3. 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:
"Contract." An agreement executed in compliance with this
act between a health care provider and a governmental contractor
that allows a health care provider, or any employee, agent or
volunteer acting on behalf of the health care provider, to
deliver health care services to low-income patients as an agent
of the governmental contractor. The contract must be for
volunteer, uncompensated services.
"Department." The Department of Health of the Commonwealth.
"Free or charitable clinic." A health care facility,
institution or other organization operated by a nonprofit
private entity that meets all of the following:
(1) whose primary mission is to provide health care
services to low-income patients free of charge or for a
minimal donation. For purposes of this definition, a free or
charitable clinic may:
(i) receive a legislative appropriation, a grant
through a legislative appropriation or a grant from a
governmental entity or nonprofit corporation to support
the delivery of contracted services by volunteer health
care providers, including the employment of health care
providers to supplement, coordinate or support the
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delivery of services by volunteer health care providers.
Such an appropriation or grant does not constitute
compensation under this act from the governmental
contractor for services provided under the contract, nor
does receipt and use of the appropriation or grant
constitute the acceptance of compensation under this act
for the specific services provided to the low-income
patients covered by the contract; and
(ii) provide health care services for a nominal fee
or a fee based on a sliding scale of rates if the clinic
provides essential health care services without regard to
the patient's ability to pay, in which case the clinic
may accept such compensation from a public or private
third-party payor.
(2) whose volunteer health care professionals provide a
significant portion of the health care services;
(3) has an independent governing board composed of a
broad representation from the community;
(4) has obtained or has applied for a tax exemption
under section 501(c)(3) of the Internal Revenue Code of 1986
(68A Stat. 3, 26 U.S.C. § 501(c)(3)), or is a program
component of a 501(c)(3) nonprofit organization that provides
other services;
(5) is committed to minimizing barriers to care and is
providing quality care; and
(6) has a varied and significant base of community
financial support and a proven ability to develop financial
and in-kind resources.
"Governmental contractor." The department, county or
municipal health departments, a special taxing district with
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health care responsibilities or a hospital owned and operated by
a governmental entity.
"Health care provider" or "provider." The term includes:
(1) Any of the following:
(i) A health care facility as defined under section
802.1 of the act of Jul. 19, 1979 (P.L.130, No.48), known
as the Health Care Facilities Act.
(ii) A physician or physician assistant as defined
under section 2 of the act of December 20, 1985 (P.L.457,
No.112), known as the Medical Practice Act of 1985.
(iii) A chiropractor licensed under the act of
December 16, 1986 (P.L.1646, No.188), known as the
Chiropractic Practice Act.
(iv) A podiatrist licensed under the act of March 2,
1956 (1955 P.L.1206, No.375), known as the Podiatry
Practice Act.
(v) A professional nurse licensed under the act of
May 22, 1951 (P.L.317, No.69), known as The Professional
Nursing Law, or a nurse, practical nurse or licensed
practical nurse licensed under the act of March 2, 1956
(P.L.1211, No.376), known as the Practical Nurse Law, or
any facility which employs such nurses to supply all or
part of the care delivered under this section.
(vi) A midwife or nurse-midwife as defined under
section 2 of the act of December 20, 1985 (P.L.457,
No.112), known as the Medical Practice Act of 1985.
(vii) A health maintenance organization holding a
certificate of authority under the act of December 29,
1972 (P.L.1701, No.364), known as the Health Maintenance
Organization Act.
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(viii) An association of licensed health care
professionals or a corporate medical group.
(ix) Any other health care facility the primary
purpose of which is to deliver human medical diagnostic
services or which delivers nonsurgical human medical
treatment, and which includes an office maintained by a
provider.
(x) A dentist or dental hygienist licensed under the
act of May 1, 1933 (P.L.216, No.76), known as The Dental
Law.
(xi) A free or charitable clinic.
(xii) Any other licensed health care professional,
health care practitioner as defined in section 103 of the
act of July 19, 1979 (P.L.130, No.48), known as the
Health Care Facilities Act, provider or health care
facility under contract with a governmental contractor,
including a student enrolled in a program at an
accredited medical college as defined under section 2 of
the act of December 20, 1985 (P.L.457, No.112), known as
the Medical Practice Act of 1985, that prepares the
student for licensure as any one of the professionals
listed in subparagraphs (ii), (iii), (iv), (v) and (vi)
of this definition.
(2) Any nonprofit corporation qualified as exempt from
federal income taxation under section 501(a) of the Internal
Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. § 501(a)),
and described in section 501(c) of the Internal Revenue Code
of 1986 (Public Law 99-514, 26 U.S.C. § 501(c)), which
delivers health care services provided by licensed
professionals listed in paragraph (1), any federally funded
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community health center and any volunteer corporation or
volunteer licensed health care provider that delivers health
care services.
"Low-income." Includes any person who is:
(1) eligible for Medicaid under the laws of this
Commonwealth;
(2) without health insurance and whose family household
income is no greater than 300% of the Federal poverty income
guidelines; or
(3) a client of the department who voluntarily chooses
to participate in a program offered or approved by the
department and meets the program eligibility guidelines of
the department.
"Patient." A natural person receiving health care in or from
a health care provider.
"Volunteer, uncompensated services." Services for which the
following conditions are met:
(1) The health care provider receives no compensation
from the governmental contractor for any services provided
under the contract.
(2) In the case of a health care provider that is not a
free or charitable clinic as defined under this act, the
health care provider does not bill or accept compensation
from the patient, or a public or private third party payor,
of the specific services provided to the low-income patient
covered by the contract, except as provided in section 4(b)
(5).
(3) In the case of a free or charitable clinic:
(i) the clinic provides health care services to low-
income patients free of charge or for a minimal donation;
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or
(ii) the clinic provides essential health care
services without regard to the patient's ability to pay
for a nominal fee or a fee based on a sliding scale of
rates, in which case the clinic may accept such
compensation from a public or private third party payor.
Section 4. Governmental immunity under contract.
(a) Governmental immunity.--The following shall apply:
(1) The following shall be considered a local agency or
employee of a local agency for purposes of 42 Pa.C.S. Ch. 85
Subch. C (relating to actions against local parties) while
acting within the scope of duties under the contract if the
contract complies with the requirements of this act and
regardless of whether the individual treated is later found
to be ineligible:
(i) a health care provider that executes a contract
with a governmental contractor to deliver health care
services as an agent of the governmental contractor; or
(ii) any employee, agent or volunteer acting on
behalf of a health care provider under subparagraph (i).
(2) A health care provider, or any employee, agent or
volunteer acting on behalf of the health care provider, shall
continue to be considered an agent for purposes of 42 Pa.C.S.
Ch. 85 Subch. C for 30 days after a determination of
ineligibility to allow for treatment until the individual
transitions to another health care provider.
(3) A health care provider under contract with the
State, or any employee, agent or volunteer acting on behalf
of a health care provider, may not be named as a defendant in
any action arising out of medical care or treatment under
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contracts entered into under this section.
(b) Contract requirements.--A contract entered into under
this section must provide that:
(1) The governmental contractor retains the right to
dismiss or terminate any health care provider delivering
services under a contract.
(2) The governmental contractor has access to the
patient records of any health care provider delivering
services under a contract.
(3) The following reports are filed:
(i) adverse incidents and information on treatment
outcomes must be reported by any health care provider to
the governmental contractor if the incidents and
information pertain to a patient treated under the
contract.
(ii) a health care provider shall submit the reports
required under Chapter 3 of the act of Mar. 20, 2002
(P.L.154, No.13), known as the Medical Care Availability
and Reduction of Error (Mcare) Act.
(iv) if an incident involves a professional or
facility licensed by the Department of State or the
Department of Health, the governmental contractor shall
submit an incident report to the appropriate professional
licensure department or board, which shall review each
incident and determine whether it involves conduct by the
licensee that is subject to disciplinary action.
(4) All patient medical records and any identifying
information contained in adverse incident reports and
treatment outcomes which are obtained by governmental
entities under this paragraph are confidential and not
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subject to disclosure under the act of February 14, 2008
(P.L.6, No.3), known as the Right-to-Know Law.
(5) If emergency care is required, the patient need not
be referred before receiving treatment, but must be referred
within 48 hours after treatment is commenced or within 48
hours after the patient has the mental capacity to consent to
treatment, whichever occurs later.
(6) A dentist or dental hygienist licensed under the act
of May 1, 1933 (P.L.216, No.76), known as The Dental Law, as
an agent of the governmental contractor for purposes of 42
Pa.C.S. Ch. 85 Subch. C (relating to actions against local
parties), may allow a patient, or a parent or guardian of the
patient, to voluntarily contribute a monetary amount to cover
costs of dental laboratory work related to the services
provided to the patient within the scope of duties under the
contract. This contribution may not exceed the actual cost of
the dental laboratory charges.
(c) A governmental contractor that is also a health care
provider is not required to enter into a contract under this
section with respect to the health care services delivered by
its employees.
Section 5. Notice of agency relationship.
(a) Initial notice.--The governmental contractor must
provide written notice to each patient, or the patient's legal
representative, that the provider is an agent of the
governmental contractor and that the exclusive remedy for injury
or damages suffered as the result of any act or omission of the
provider or of any employee, agent or volunteer acting on the
provider's behalf, if the individual acted within the scope of
duties pursuant to the contract is by commencement of an action
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pursuant to 42 Pa.C.S. Ch. 85 Subch. C (relating to actions
against local parties).
(b) Receipt of notice.--Receipt of the notice under
subsection (a) must be acknowledged by the patient or the
patient's legal representative in writing at the initial visit.
(c) Posting notice.--Following the delivery of notice under
subsection (a), with respect to any federally funded community
health center, the notice requirement may be met by the
conspicuous posting of a notice that the health care provider is
an agent of a governmental contractor and that the exclusive
remedy for injury or damage suffered as the result of any act or
omission of the provider or of any employee, agent or volunteer
acting on the provider's behalf, if the individual acted within
the scope of duties pursuant to the contract, is by commencement
of an action pursuant to 42 Pa.C.S. Ch. 85 Subch. C (relating to
actions against local parties).
Section 6. Quality assurance program required.
The governmental contractor shall establish a quality
assurance program to monitor services delivered under any
contract between a governmental contractor and a health care
provider under this act.
Section 7. Reporting requirements.
(a) Report to General Assembly.--Annually, the department
shall submit a report in writing summarizing the efficacy of
access and treatment outcomes with respect to providing health
care services for low-income persons pursuant to this act to:
(1) the standing committee on Public Health and Welfare
of the Senate; and
(2) the standing committee on Health and Human Services
of the House of Representatives.
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(b) The department shall publish a list of all providers
participating in this program and the number of volunteer
service hours and patient visits each provided on the
department's publicly accessible Internet website. A provider
may request in writing to the department to be excluded from the
online listing.
Section 8. Rules and regulations.--
(a) Department responsibilities.--The department shall adopt
reasonable rules and regulations to administer this act in a
manner consistent with its purpose to provide and facilitate
access to appropriate, safe and cost-effective health care
services and to maintain health care quality.
(b) Additional rules for free or charitable clinics.--The
department shall not adopt rules and regulations under this act
that impose additional requirements or restrictions on free or
charitable clinics than those imposed on free clinics or free
clinic health professionals deemed employees of the Public
Health Service under section 224 of the Public Health Service
Act (58 Stat. 682, 42 U.S.C. 233).
Section 9. Effective date.
This act shall take effect in 60 days.
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