HB 2128 — An Act amending the act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act, in licensing of health care facilities, further providing for definitions, for licensure and for issuance of license; and, in general provisions, repeals and effective date, providing for confidentiality.

Bill Text

• Printer's No. 3103 View text Current pdf

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

The bill amends the Health Care Facilities Act to include new definitions related to integrated delivery networks and establishes new requirements for hospitals operating within such networks.

• Section 802.1

  "Default provider agreement." An agreement between a hospital that is part of an integrated delivery network and a willing health insurance carrier to provide health care services, which agreement is imposed upon the parties in the event that they fail to enter into a mutually agreeable contract.

  Defines 'Default provider agreement' for hospitals within integrated delivery networks.

• Section 802.1

  "Health insurance carrier." An entity licensed in this Commonwealth to issue health insurance, subscriber contracts, certifications or plans that provide medical or health care coverage by a health care facility or licensed health care provider that is offered or governed under this act or any of the following: (1) The act of December 29, 1972 (P.L.1701, No.364), known as the 'Health Maintenance Organization Act.' (2) The act of May 18, 1976 (P.L.123, No.54), known as the 'Individual Accident and Sickness Insurance Minimum Standards Act.' (3) 40 Pa.C.S. Chs. 61 (relating to hospital plan corporations) and 63 (relating to professional health services plan corporations).

  Defines 'Health insurance carrier' to clarify the entities involved in health insurance provision.

• Section 802.1

  "Integrated delivery network." One or more entities with common ownership, operation or control that include both of the following: (1) One or more hospitals, one or more physician practices or one or more health care providers offering health care services. (2) One or more entities operating as a health insurance carrier offering health insurance, administering health benefits, operating a health maintenance organization or offering other health care benefits and coverage to employers or individuals in this Commonwealth.

  Defines 'Integrated delivery network' to clarify what constitutes such networks in health care.

• Section 806

  (j) Hospitals operating as part of an integrated delivery network.-- (1) In addition to complying with the standards and regulations promulgated under this section, hospitals operating as part of an integrated delivery network or an entity directly or indirectly owned, operated or controlled as part of these entities shall contract with any health insurance carrier that is willing to enter into a contract.

  Requires hospitals in integrated delivery networks to contract with willing health insurance carriers.

• Section 806

  (2) When contracting with health insurance carriers, hospitals operating as part of an integrated delivery network shall be: (i) prohibited from using contractual provisions and engaging in business practices that impede the availability of health care and that restrict access to facilities based solely on the type of insurance coverage offered by a health insurance carrier; (ii) prohibited from incorporating contractual provisions that limit or preclude the use of tiered networks by health insurance carriers; (iii) prohibited from using any portion of the reimbursement rate to subsidize a health insurance carrier operating as part of the same integrated delivery network; (iv) prohibited from incorporating a termination provision with a health insurance carrier for reasons other than a willful breach of contract; and (v) permitted to contract for services at reimbursement rates that are based upon sound actuarial data.

  Establishes prohibitions and permissions for hospitals in integrated delivery networks regarding contracts with health insurance carriers.

• Section 806

  (3) Failure of a hospital operating as part of an integrated delivery network and a willing health insurance carrier to maintain a mutually agreeable contract shall result in the parties entering into a default provider agreement while they submit to mandatory binding arbitration.

  Creates a process for arbitration if hospitals and health insurers cannot agree on contracts.

• Section 808(a)

  and → and (7) that, in the case of a hospital operating as part of an integrated delivery network, the facility: (i) has contracts with all willing health insurance carriers; (ii) does not place restrictive covenants in its employment contracts that restrain a health care practitioner from engaging in his lawful profession; and (iii) has submitted an attestation statement to the department and the Insurance Department certifying that no portion of a reimbursement rate with a health insurance carrier is subsidizing the health insurance carrier operating as part of the same integrated delivery network.

  Adds new licensure standards for hospitals operating within integrated delivery networks.

• Section 902.2

  (a) Received materials.--Insurance contracts, documents, materials or information received by the department or Insurance Department from a hospital for the purpose of compliance with this act and regulations developed pursuant to this act shall be confidential.

  Establishes confidentiality for materials received from hospitals regarding compliance with the act.

Action History

1. March 09, 2018

   PN 3103 Referred to HEALTH

Sponsors

• Christiana · Primary
• Millard · Cosponsor
• Ward · Cosponsor

Subjects