Bill Text: PA SB704 | 2009-2010 | Regular Session | Introduced

---

Bill Title: 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.

Spectrum: Partisan Bill (Democrat 12-0)

Status: (Introduced - Dead) 2009-05-27 - Referred to BANKING AND INSURANCE [SB704 Detail]

Download: Pennsylvania-2009-SB704-Introduced.html

---

PRINTER'S NO. 1035
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 704 Session of2009
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
20090SB0704PN1035 - 2 -
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.
20090SB0704PN1035 - 3 -
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
20090SB0704PN1035 - 4 -
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
20090SB0704PN1035 - 5 -
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.
20090SB0704PN1035 - 6 -