THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY RAFFERTY, ERICKSON, ORIE, WARD, ARGALL, KASUNIC, WASHINGTON, ALLOWAY, GREENLEAF, LEACH, TOMLINSON, PIPPY, MENSCH, BOSCOLA, O'PAKE, BAKER, STACK, LOGAN AND FONTANA, MARCH 19, 2010

REFERRED TO BANKING AND INSURANCE, MARCH 19, 2010  

AN ACT

Amending the act of March 20, 2002 (P.L.154, No.13), entitled

"An act reforming the law on medical professional liability;

providing for patient safety and reporting; establishing the

Patient Safety Authority and the Patient Safety Trust Fund;

abrogating regulations; providing for medical professional

liability informed consent, damages, expert qualifications,

limitations of actions and medical records; establishing the

Interbranch Commission on Venue; providing for medical

professional liability insurance; establishing the Medical

Care Availability and Reduction of Error Fund; providing for

medical professional liability claims; establishing the Joint

Underwriting Association; regulating medical professional

liability insurance; providing for medical licensure

regulation; providing for administration; imposing penalties;

and making repeals," further providing for medical

professional liability insurance, for Medical Care

Availability and Reduction of Error Fund and for actuarial

data.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Sections 711(d), 712(c)(2) and (e)(3) and 745 of

the act of March 20, 2002 (P.L.154, No.13), known as the Medical

Care Availability and Reduction of Error (Mcare) Act, are

amended to read:

Section 711.  Medical professional liability insurance.

* * *

(d)  Basic coverage limits.--A health care provider shall

insure or self-insure medical professional liability in

accordance with the following:

(1)  For policies issued or renewed in the calendar year

2002, the basic insurance coverage shall be:

(i)  $500,000 per occurrence or claim and $1,500,000

per annual aggregate for a health care provider who

conducts more than 50% of its health care business or

practice within this Commonwealth and that is not a

hospital.

(ii)  $500,000 per occurrence or claim and $1,500,000

per annual aggregate for a health care provider who

conducts 50% or less of its health care business or

practice within this Commonwealth.

(iii)  $500,000 per occurrence or claim and

$2,500,000 per annual aggregate for a hospital.

(2)  For policies issued or renewed in the calendar years

2003, 2004 and 2005, and each year thereafter, the basic

insurance coverage shall be:

(i)  $500,000 per occurrence or claim and $1,500,000

per annual aggregate for a participating health care

provider that is not a hospital.

(ii)  $1,000,000 per occurrence or claim and

$3,000,000 per annual aggregate for a nonparticipating

health care provider.

(iii)  $500,000 per occurrence or claim and

$2,500,000 per annual aggregate for a hospital.

[(3)  Unless the commissioner finds pursuant to section

745(a) that additional basic insurance coverage capacity is

not available, for policies issued or renewed in calendar

year 2006 and each year thereafter subject to paragraph (4),

the basic insurance coverage shall be:

(i)  $750,000 per occurrence or claim and $2,250,000

per annual aggregate for a participating health care

provider that is not a hospital.

(ii)  $1,000,000 per occurrence or claim and

$3,000,000 per annual aggregate for a nonparticipating

health care provider.

(iii)  $750,000 per occurrence or claim and

$3,750,000 per annual aggregate for a hospital.

If the commissioner finds pursuant to section 745(a) that

additional basic insurance coverage capacity is not

available, the basic insurance coverage requirements shall

remain at the level required by paragraph (2); and the

commissioner shall conduct a study every two years until the

commissioner finds that additional basic insurance coverage

capacity is available, at which time the commissioner shall

increase the required basic insurance coverage in accordance

with this paragraph.

(4)  Unless the commissioner finds pursuant to section

745(b) that additional basic insurance coverage capacity is

not available, for policies issued or renewed three years

after the increase in coverage limits required by paragraph

(3) and for each year thereafter, the basic insurance

coverage shall be:

(i)  $1,000,000 per occurrence or claim and

$3,000,000 per annual aggregate for a participating

health care provider that is not a hospital.

(ii)  $1,000,000 per occurrence or claim and

$3,000,000 per annual aggregate for a nonparticipating

health care provider.

(iii)  $1,000,000 per occurrence or claim and

$4,500,000 per annual aggregate for a hospital.

If the commissioner finds pursuant to section 745(b) that

additional basic insurance coverage capacity is not

available, the basic insurance coverage requirements shall

remain at the level required by paragraph (3); and the

commissioner shall conduct a study every two years until the

commissioner finds that additional basic insurance coverage

capacity is available, at which time the commissioner shall

increase the required basic insurance coverage in accordance

with this paragraph.]

* * *

Section 712.  Medical Care Availability and Reduction of Error

Fund.

* * *

(c)  Fund liability limits.--

* * *

(2)  The limit of liability of the fund for each

participating health care provider shall be [as follows:

(i)  For calendar year 2003 and each year thereafter,

the limit of liability of the fund shall be] $500,000 for

each occurrence and $1,500,000 per annual aggregate.

[(ii)  If the basic insurance coverage requirement is

increased in accordance with section 711(d)(3) and,

notwithstanding subparagraph (i), for each calendar year

following the increase in the basic insurance coverage

requirement, the limit of liability of the fund shall be

$250,000 for each occurrence and $750,000 per annual

aggregate.

(iii)  If the basic insurance coverage requirement is

increased in accordance with section 711(d)(4) and,

notwithstanding subparagraphs (i) and (ii), for each

calendar year following the increase in the basic

insurance coverage requirement, the limit of liability of

the fund shall be zero.]

* * *

(e)  Discount on surcharges and assessments.--

* * *

[(3)  For calendar years 2005 and thereafter, if the

basic insurance coverage requirement is increased in

accordance with section 711(d)(3) or (4), the department may

discount the aggregate assessment imposed under subsection

(d) by an amount not to exceed the aggregate sum to be

deposited in the fund in accordance with subsection (m).]

* * *

[Section 745.  Actuarial data.

(a)  Initial study.--The following shall apply:

(1)  No later than April 1, 2005, each insurer providing

medical professional liability insurance in this Commonwealth

shall file loss data as required by the commissioner. For

failure to comply, the commissioner shall impose an

administrative penalty of $1,000 for every day that this data

is not provided in accordance with this paragraph.

(2)  By July 1, 2005, the commissioner shall conduct a

study regarding the availability of additional basic

insurance coverage capacity. The study shall include an

estimate of the total change in medical professional

liability insurance loss-cost resulting from implementation

of this act prepared by an independent actuary. The fee for

the independent actuary shall be borne by the fund. In

developing the estimate, the independent actuary shall

consider all of the following:

(i)  The most recent accident year and ratemaking

data available.

(ii)  Any other relevant factors within or outside

this Commonwealth in accordance with sound actuarial

principles.

(b)  Additional study.--The following shall apply:

(1)  Three years following the increase of the basic

insurance coverage requirement in accordance with section

711(d)(3), each insurer providing medical professional

liability insurance in this Commonwealth shall file loss data

with the commissioner upon request. For failure to comply,

the commissioner shall impose an administrative penalty of

$1,000 for every day that this data is not provided in

accordance with this paragraph.

(2)  Three months following the request made under

paragraph (1), the commissioner shall conduct a study

regarding the availability of additional basic insurance

coverage capacity. The study shall include an estimate of the

total change in medical professional liability insurance

loss-cost resulting from implementation of this act prepared

by an independent actuary. The fee for the independent

actuary shall be borne by the fund. In developing the

estimate, the independent actuary shall consider all of the

following:

(i)  The most recent accident year and ratemaking

data available.

(ii)  Any other relevant factors within or outside

this Commonwealth in accordance with sound actuarial

principles.]

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