Bill Text: PA HB32 | 2011-2012 | Regular Session | Introduced


Bill Title: Further providing for rates and contracts.

Spectrum: Moderate Partisan Bill (Democrat 54-7)

Status: (Introduced - Dead) 2011-10-13 - Referred to INSURANCE [HB32 Detail]

Download: Pennsylvania-2011-HB32-Introduced.html

  

 

    

PRINTER'S NO.  2540

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

32

Session of

2011

  

  

INTRODUCED BY DeLUCA, FRANKEL, MICOZZIE, VULAKOVICH, DERMODY, MARKOSEK, BARBIN, B. BOYLE, BRENNAN, BRIGGS, CALTAGIRONE, COHEN, CONKLIN, D. COSTA, P. COSTA, CURRY, DALEY, DAVIS, DEASY, DePASQUALE, DeWEESE, J. EVANS, FABRIZIO, FREEMAN, GALLOWAY, GEORGE, GIBBONS, HALUSKA, HANNA, HARHAI, HARKINS, HORNAMAN, JOSEPHS, KIRKLAND, KORTZ, KOTIK, KULA, LONGIETTI, MAHONEY, MARSHALL, MATZIE, MIRABITO, MUNDY, MUSTIO, M. O'BRIEN, PASHINSKI, PRESTON, PYLE, READSHAW, SAINATO, SANTARSIERO, SANTONI, M. SMITH, SONNEY, STABACK, STURLA, THOMAS, WATERS, WHITE, WILLIAMS AND YOUNGBLOOD, OCTOBER 13, 2011

  

  

REFERRED TO COMMITTEE ON INSURANCE, OCTOBER 13, 2011  

  

  

  

AN ACT

  

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Amending Title 40 (Insurance) of the Pennsylvania Consolidated

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Statutes, further providing for rates and contracts.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  Section 6124(c) of Title 40 of the Pennsylvania

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Consolidated Statutes is amended to read:

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§ 6124.  Rates and contracts.

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* * *

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(c)  Maintenance of contractual relationships.--

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(1)  Declaration of necessity.--

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(i)  It is hereby found that many subscribers to

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nonprofit hospital plans make payments over long periods

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of time prior to becoming entitled to benefits under such

 


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a plan and that it is important in the public interest

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that the reasonable expectations of such subscribers as

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to coverage should be fulfilled if possible. It is hereby

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declared to be essential for the maintenance of the

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health of the residents of this Commonwealth that

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subscribers to nonprofit hospital plans be assured

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receipt of the hospitalization and related health

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benefits prepaid by them through payment of the rates

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approved under this chapter and charged by a hospital

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plan corporation and that to accomplish this essential

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purpose termination of contracts between hospital plan

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corporations and hospitals entered into pursuant to

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section 6121 (relating to eligible hospitals) and this

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section be subject to prior approval by the department as

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provided in this subsection.

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(ii)  It is further found that providing meaningful

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health care choices to the residents of this Commonwealth

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is essential to the provision of and accessibility to

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quality health care at an affordable price. It is hereby

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declared to be equally essential for the maintenance of

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the health of the residents of this Commonwealth that

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subscribers to nonprofit hospital plans be assured

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continued receipt of adequate hospitalization and related

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health benefits upon the expiration of contracts between

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hospital plan corporations and hospitals entered into

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pursuant to section 6121 (relating to eligible hospitals)

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and this section be subject to prior approval by the

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department as provided in this subsection.

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(2)  Notification period.--

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(i)  No contract between a hospital plan corporation

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and any hospital providing for the rendering of

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hospitalization to subscribers to the hospital plan shall

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be terminated unless the party seeking such termination

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gives 90 days advance written notice to the other party

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to the contract and to the department of the proposed

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termination.

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(ii)  A hospital plan corporation that has entered

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into a contract with a hospital providing for the

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rendering of hospitalization to subscribers to the

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hospital plan corporation shall give the department at

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least 90 days' advance written notice of the expiration

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date provided for in the contract.

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(3)  Hearing period.--Whenever a termination or

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expiration subject to paragraph (2) involves contracts with

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hospitals having more than 5% of the beds in the area served

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by a hospital plan corporation, the department shall hold

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public hearings on at least 15 days notice for the purpose of

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investigating the reasons for the termination or whether the

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pending expiration is in the public interest. Pending

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completion of said investigation by the department,

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termination or expiration of the hospital contracts shall be

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suspended for a period not to exceed six months from the

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expiration of the period provided for in paragraph (2). All

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terms and conditions of the [contract] contracts between the

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hospital plan corporation and the hospital or hospitals shall

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continue in full force and effect during said investigation

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by the department. Based on the record made during the

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hearings, the department shall make specific findings [as to

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the] of facts [of the dispute] and shall either approve

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termination or expiration of the contracts or recommend such

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terms for continuation of the [contract] contracts as are in

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the public interest, based upon the facts, the right of a

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hospital to be paid its costs for hospitalization services to

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subscribers [and], the need of subscribers for efficient,

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reliable hospitalization at a reasonable cost and the

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adequacy of the alternative health system networks that would

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be accessible to subscribers in the event the contracts are

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permitted to terminate or expire. The Department of Health

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shall determine whether the alternative health system

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networks are adequate under the requirements of the act of

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December 29, 1972 (P.L.1701, No.364), known as the Health

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Maintenance Organization Act, and the regulations promulgated

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under that act.

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(4)  Negotiation period.--If the department recommends

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terms for continuation of the [contract] contracts, the

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hospital plan corporation and the hospitals involved shall

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renew their negotiations in order to determine whether a new

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agreement can be reached substantially on the basis of the

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terms for continuation recommended by the department and

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pending such negotiations, the termination or expiration of

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the hospital contracts shall be suspended for a further

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period not to exceed 90 days from the date of the decision of

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the department. If the hospital plan corporation and the

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hospitals are unable to consummate [a new contract] new

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contracts within said further period of 90 days, they shall

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so advise the department[. The department shall in that

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event], and the contracts in effect prior to the giving of

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notice provided under paragraph (2) shall remain in full

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force and effect for a term equal to the initial or any

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subsequent renewal term, whichever is longer, provided for in

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the contracts. If the department recommends that the

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contracts be permitted to be terminated or to expire, the

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department shall approve termination or expiration of the

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contracts effective at the end of a further period of 30 days

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and shall prescribe the form and extent of notice which the

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hospital plan corporation shall use in advising its

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subscribers that hospitalization in the hospitals involved is

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not covered by a contract between the hospital plan

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corporation and such hospitals.

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(5)  Retroactivity.--Upon the settlement of any dispute

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between a hospital plan corporation and any hospital pursuant

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to paragraphs (2) and (4), the terms and conditions of any

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new contract shall be retroactive to the date of termination

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or expiration of the contract previously in effect between

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the parties.

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

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