An Act amending Title 35 (Health and Safety) of the Pennsylvania Consolidated Statutes, establishing an All Payor Claims Database; imposing duties on the Health Care Cost Containment Council; imposing penalties; and making an appropriation.

PRINTER'S NO. 2141
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1739
Session of
2025
INTRODUCED BY KHAN, ABNEY, WAXMAN, HILL-EVANS, GUENST, SANCHEZ,
HOHENSTEIN, MAYES AND BELLMON, JULY 15, 2025
REFERRED TO COMMITTEE ON HEALTH, JULY 16, 2025
AN ACT
Amending Title 35 (Health and Safety) of the Pennsylvania
Consolidated Statutes, establishing an All Payor Claims
Database; imposing duties on the Health Care Cost Containment
Council; imposing penalties; and making an appropriation.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 35 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 34
ALL PAYOR CLAIMS DATABASE
Sec.
3401. Scope of chapter.
3402. Declaration of policy.
3403. Definitions.
3404. Establishment of database.
3405. Contracting authority.
3406. Advisory group.
3407. Data collection.
3408. Technical guidance.
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3409. Data analysis and review.
3410. Public reports and databases.
3411. Confidentiality and information sharing.
3412. Grievances.
3413. Enforcement and penalties.
§ 3401. Scope of chapter.
This chapter relates to establishing an All Payor Claims
Database.
§ 3402. Declaration of policy.
The General Assembly finds and declares that the
establishment of an All Payor Claims Database would:
(1) Facilitate the reporting of health care and health
quality data.
(2) Promote the transparency of the price of health care
services through easily understandable and reliable public
reporting that will enable consumers to assess quality and
out-of-pocket costs before receiving health care services.
(3) Support the regulation of health insurance and
health insurers by the Insurance Department.
(4) Support payors for and providers of health care
services in assessing alternative payment models, including
value-based care models.
(5) Assist regulators in analyzing health care spending
trends across different payor types, including Medicaid,
CHIP, Medicare and commercial insurance.
(6) Support the analysis of market transactions
involving health care providers or payors.
(7) Enable national, regional and state-by-state
comparisons of health care costs.
§ 3403. Definitions.
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The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"All Payor Claims Database" or "APCD." The database
established under section 3404 (relating to establishment of
database).
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Council." The Health Care Cost Containment Council.
"Data." Information submitted by a provider to a payor
relating to a claim for payment for a rendered health care
service.
"Elective payor." A person not otherwise required to comply
with the insurance laws of this Commonwealth, including an
employer-sponsored self-funded health plan or a Taft-Hartley
trust health plan, that elects to voluntarily provide claims
data to the APCD within the time frames and in accordance with
procedures established by the council.
"Facility." A health care setting or institution providing a
health care service, including:
(1) A general, special, psychiatric, rehabilitation or
other hospital.
(2) An ambulatory surgical facility.
(3) A cancer treatment center.
(4) A birth center.
(5) A skilled nursing center.
(6) An inpatient, outpatient or residential drug and
alcohol treatment facility.
(7) A facility licensed by the Department of Human
Services' Office of Mental Health and Substance Abuse
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Services.
(8) A laboratory, imaging, diagnostic or other
outpatient medical service or testing facility.
(9) A provider office or clinic.
(10) An urgent care center.
(11) A stand-alone emergency care facility.
"Health care service." A treatment, admission, procedure,
medical supply or equipment, pharmaceutical or other medical
health or mental health service prescribed, rendered or
otherwise provided or proposed to be provided to an enrollee,
policyholder, certificate-holder, subscriber or other individual
who is entitled to receive health care services under a payor
payment arrangement in this Commonwealth for the diagnosis,
prevention, treatment, cure or relief of a health condition,
illness, injury or disease or functional limitation, including
emergency medical services as defined in section 8103 (relating
to definitions) and pharmacy benefits management as defined in
section 103 of the act of November 21, 2016 (P.L.1318, No.169),
known as the Pharmacy Audit Integrity and Transparency Act.
"Health insurer." An entity licensed in this Commonwealth to
issue health insurance, subscriber contracts, certifications or
plans that provide medical or health care coverage by a provider
that is offered or governed under:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Chs. 61 (relating to hospital plan
corporations) and 63 (relating to professional health
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services plan corporations).
"Out-of-pocket costs." Costs charged directly to an
individual for services received by the individual or the
individual's dependent, including deductibles, co-insurance,
copayments and similar out-of-pocket expenses.
"Payor." A person that makes payments to facilities or
providers for health care services rendered to an enrollee,
policyholder, certificate holder, subscriber or other individual
who is entitled to receive health care services under a health
insurance policy or other payor payment arrangement. The term
does not include an individual making a payment for out-of-
pocket costs.
"Payor payment arrangement." A promise to pay for health
care services. The term does not include a health insurance
policy.
"Provider." A person licensed, certified or otherwise
authorized or permitted by the laws of this Commonwealth or any
other state to provide or perform a health care service in the
ordinary course of business or practice and any other person
that furnishes, bills or is paid for a health care service in
the normal course of business, including, but not limited to, a
physician, podiatrist, optometrist, psychologist, physical
therapist, certified nurse practitioner, registered nurse, nurse
midwife, physician's assistant, chiropractor, dentist,
pharmacist, individual accredited or certified to provide
behavioral health services, a facility, nursing home, assisted
living provider, home health agency, medical equipment supplier,
emergency medical services agency or an individual providing an
emergency service on behalf of an emergency medical services
agency as those terms are defined in section 8103 (relating to
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definitions) or any other health care provider as defined under
45 CFR 160.103 (relating to definitions).
"Purchaser." A corporation, labor organization or other
person that purchases benefits which provide health care
services for employees or members, either through a health care
insurer or by means of a self-funded program of benefits and a
certified bargaining representative that represents a group or
groups of employees for whom employers purchase a program of
benefits which provide health care services. The term does not
include a health insurer.
§ 3404. Establishment of database.
(a) Establishment.--The All Payor Claims Database shall be
established within 60 days of receipt of an appropriation under
subsection (b)(1). Prior to establishment of the APCD, the
commissioner may take action necessary to effectuate the prompt
establishment of the APCD, including, on behalf of the council,
to contract with one or more vendors for initial development of
the APCD.
(b) Appropriations.--
(1) The General Assembly:
(i) Shall appropriate not less than $4,000,000 for
the establishment of the APCD.
(ii) May annually appropriate General Fund money to
the council to pay for expenses related to the APCD.
(2) If there is not sufficient funding to finance the
ongoing operations of the APCD, the council shall cease APCD
operations. If the APCD ceases to operate, the data submitted
shall be destroyed or returned to its original source.
(c) Council duties.--The council shall:
(1) Oversee the collection, aggregation and analysis of
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data collected under sections 3407 (relating to data
collection) and 3409 (relating to data analysis and review).
(2) Establish data access policies in accordance with
sections 3410 (relating to public reports and databases) and
3411 (relating to confidentiality and information sharing).
(3) Develop and implement data privacy and security
protocols to safeguard against the misuse of data and ensure
patient confidentiality and compliance with applicable
Federal and State privacy laws and regulations, including the
Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191, 110 Stat. 1936), the Health Information
Technology for Economic and Clinical Health Act (Public Law
111-5, 123 Stat. 226-279 and 467-496) and implementing
regulations.
(4) Implement the reporting requirements in a cost-
effective and reasonable manner to produce reliable and
timely information.
(5) Determine the reports and data on quality, health
outcomes, health disparities, cost, utilization and pricing
to be made available to the public.
(6) Make recommendations for further study and data
collection to carry out the purposes of this chapter and
facilitate informed choices by consumers .
§ 3405. Contracting authority.
(a) Procurements.--In addition to and consistent with any
contract entered into by the commissioner under section 3404(a)
(relating to establishment of database), the council shall
contract with one or more vendors for the development and
maintenance of the APCD.
(b) Requirements and considerations.--
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(1) A vendor must satisfy the requirements of 42 CFR
401.705 (relating to eligibility criteria for qualified
entities) and 401.707 (relating to operating and governance
requirements for qualified entities).
(2) The council shall consider all of the following in
determining a vendor:
(i) The vendor's degree of experience in health care
data collection, analysis, analytics and security.
(ii) Whether the vendor has a long-term self-
sustainable financial model.
(iii) The vendor's experience in convening and
effectively engaging stakeholders to develop reports,
especially among groups of health providers, health
insurers, carriers and self-insured purchasers.
(iv) The vendor's experience in meeting budget and
time lines for report generation.
(v) The vendor's ability to combine cost and quality
data to assess total cost of care.
(c) Use of experts.--
(1) The council may contract with competent experts,
including legal, actuarial or economic experts, to assist the
council in the review of any matter within the scope of this
chapter, including auditing the accuracy of data submitted.
The council may bill reasonable and necessary costs for the
services of an expert to:
(i) the nongovernmental payors on a pro rata basis
based on the number of covered lives in proportion to all
covered lives by those nongovernmental payors; or
(ii) a data supplier if the services are particular
as to that data supplier, other than a governmental
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payor.
(2) Within 30 days of its receipt of a bill for the
services, the payor shall make payment directly to the expert
and shall provide confirmation of payment to the council.
(d) Procurements within one year.--The contracts entered
into under this section shall be subject to the requirements of
section 3314 (relating to contracts with vendors) for one year
after the effective date of this subsection.
§ 3406. Advisory group.
In addition to the advisory groups established under section
3303(g) and (h) (relating to Health Care Cost Containment
Council), the council shall establish an APCD advisory group
that shall include the Secretary of Health, the Secretary of
Human Services and the commissioner, who shall be chairman. The
duties of the APCD advisory group shall include, but not be
limited to, advising the council on the following:
(1) The data elements to be collected and methods of
collection.
(2) The reporting formats for data submitted.
(3) The use and reporting of any data submitted.
(4) Coordination of public and private health care
quality and performance measures.
(5) The utilization of publicly available data in
combination with data collected by the APCD, where
appropriate.
(6) The types of reports to be made available to the
public.
(7) The types of databases to be maintained to
facilitate independent research and consumer usability.
§ 3407. Data collection.
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(a) Data suppliers.--The following persons shall submit data
to the council upon request:
(1) Nongovernmental payors, including:
(i) Insurers, including health insurers, for
policies subject to regulation by the Insurance
Department under which a claim described in subsection
(b) is paid, including policies that provide the
following types of coverage:
(A) Health insurance.
(B) Accident only.
(C) Credit only.
(D) Long-term care or disability income.
(E) Specified disease.
(F) Medicare supplement.
(G) Fixed indemnity.
(H) Dental only.
(I) Vision only.
(J) Workers' compensation.
(K) Automobile medical payment.
(L) Any other coverage policy regulated by the
Insurance Department under which health care claims
may be paid.
(ii) Issuers or administrators of coverage under
Medicare Advantage Part C under Title XVIII of the Social
Security Act (49 Stat. 620, 42 U.S.C. § 1395 et seq.),
insofar as not prohibited by Federal law .
(iii) Third-party administrators paying claims on
behalf of health plans in this Commonwealth, for:
(A) Fully insured health plans.
(B) Elective payors, at the direction of the
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elective payor.
(2) Governmental payors, including:
(i) The Commonwealth's Medical Assistance program
established under the act of June 13, 1967 (P.L.31,
No.21), known as the Human Services Code, including
entities contracted to provide services under the
program.
(ii) The Children's Health Insurance Program under
Article XXIII-A of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921,
including entities contracted to provide services under
the program.
(iii) Health care coverage provided by the
Commonwealth, a county, a city or other State or local
governmental entity or an agency, subdivision or
department of a governmental entity, including:
(A) A corporation or other arrangement organized
by the entity for the provision of health care
coverage and subject to control by the entity or an
instrumentality of the entity .
(B) The Pennsylvania Employee Benefit Trust Fund
for active and retired employees.
(iv) Issuers or administrators of coverage under
Medicare Parts A and B under Title XVIII of the Social
Security Act, insofar as not prohibited by Federal law.
(v) Issuers or administrators of policies under
which benefits are provided by the Federal Government to
active or former military personnel and their dependents,
insofar as not prohibited by Federal law.
(vi) Issuers or administrators of a health care plan
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provided through the Federal Employees Health Benefits
Program established under 5 U.S.C. Ch. 89 (relating to
health insurance), insofar as not prohibited by Federal
law.
(3) Providers.
(4) Facilities.
(b) Claims data subject to collection.--The data provided
under subsection (a) must be provided for at least the
following:
(1) Types of claims:
(i) Medical health.
(ii) Mental health.
(iii) Dental health.
(iv) Substance use disorders.
(v) Emergency services, including transport and
care .
(vi) Pharmaceuticals.
(vii) Durable medical equipment.
(2) Types of providers:
(i) Inpatient.
(ii) Outpatient, including at ambulatory surgical
facilities.
(iii) Primary.
(iv) Specialist.
(v) Pharmacy.
(c) Categories of data.--The council shall collect data as
to each type of claim identified in subsection (b) to include:
(1) Demographic information, including the patient's
gender, age and geographic area of residency.
(2) Information relating to an individual episode of
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care, including the date and time of the patient's admission
and discharge, the identity of the health care services
provider and the location and type of facility, such as a
hospital, office or clinic, where the service was provided.
(3) Information describing the nature of health care
services provided to the patient in connection with the
encounter, visit or service, including diagnosis codes.
(4) Health insurance product type, such as HMO or PPO.
(5) Pricing and payment information, including a
facility's or provider's billed and accepted amounts, a
payor's allowed and paid amounts and a consumer's out-of-
pocket costs.
(6) Service frequency data, including admission and re-
admission and visit frequency data.
(7) Patient engagement and compliance data, including
medication adherence.
(d) Format of data submission.--The council is authorized to
collect, and data suppliers are required to submit upon request
of the council, all data required in this section in a uniform
format.
(e) Timing of data submission.--Each data supplier shall
timely submit all data required in this section in accordance
with the following:
(1) On or before the 15th day of each month, each data
supplier shall submit data relating to the prior month.
(2) On or before April 1 of each year following the
effective date of this paragraph, each data supplier shall
submit an annual report compiling the data relating to the
prior calendar year.
(f) Submission.--Unless modified or supplemented by
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regulations promulgated under this chapter, in instances where
more than one entity is involved in the administration of a
policy, a health insurer shall be responsible for submitting the
claims data for policies that the health insurer has written,
and the third-party administrator shall be responsible for
submitting claims data for elective payor plans that it
administers.
(g) Administrative penalties.--
(1) A data supplier that fails to submit data shall be
subject to an administrative penalty of $1,000 for each day
that the required data is not provided in accordance with
this section.
(2) A data supplier that fails to correct data as
required under subsection (h)(2) within 30 days of the
request to correct the data shall be subject to an
administrative penalty of $1,000 for each day that the
required corrected data is not provided in accordance with
this section.
(3) A data supplier may be subject to the administrative
penalties in paragraph (1) and (2).
(h) Review and correction.--
(1) The council's vendor shall review and validate all
data submitted within 60 days of receipt.
(2) If data fails validation, the council's vendor shall
direct a data source to correct the data within 30 days.
§ 3408. Technical guidance.
(a) Content.--
(1) The council shall publish technical guidance, in
accordance with subsection (b), to establish uniform
submission formats, coding systems and other technical
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specifications necessary to render the incoming data
substantially valid, consistent, compatible and manageable
using electronic data processing according to data submission
schedules.
(2) Technical guidance shall avoid, to the extent
possible, submission of identical data from more than one
data supplier. The uniform submission formats, coding systems
and other technical specifications may be established by the
council pursuant to its authority under section 3304
(relating to power and duties of council). If payor data is
requested by the council, it shall, to the extent possible,
be obtained from primary payor sources. The council shall not
require a data supplier to contract with any specific vendor
for submission of any specific data elements to the council.
(b) Publication and notice.--The council shall publish
technical guidance under this subsection not more than once each
year in accordance with the following:
(1) The council shall publish draft and final technical
guidance by transmitting notice to the Legislative Reference
Bureau for publication in the next available issue of the
Pennsylvania Bulletin and by:
(i) Posting the technical guidance on the council's
publicly accessible Internet website.
(ii) Electronically sending notice to the chair and
minority chair of the Banking and Insurance Committee of
the Senate, the chair and minority chair of the Insurance
Committee of the House of Representatives, the chair and
minority chair of the Health and Human Services Committee
of the Senate and the chair and minority chair of the
Health Committee of the House of Representatives.
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(iii) Electronically sending notice to a contact
person or electronic mailing address as identified by the
person, to the council, of the Hospital Association of
Pennsylvania or a successor organization, the
Pennsylvania Medical Society, or a successor organization
and all health insurers offering comprehensive health
insurance to the individual in this Commonwealth.
(2) There shall be a 60-day comment period after
publication of draft technical guidance.
(3) Final technical guidance shall be published in
accordance with paragraph (1) and may not take effect until
30 days after the end of the comment period under paragraph
(2).
§ 3409. Data analysis and review.
The council and a vendor retained under section 3405
(relating to contracting authority) shall provide access to the
data and provide data analysis upon request to:
(1) The Insurance Department, for use in at least the
following:
(i) Product regulation, including form and rate
review.
(ii) Network adequacy regulation.
(iii) Market actions, investigations, examinations
and other enforcement actions.
(iv) Promoting price and quality transparency for
consumers.
(v) Mediating contract negotiations between
providers and payors.
(2) The Department of Health and the Department of Human
Services, for use in at least the following:
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(i) Analyzing health care spending trend analysis,
including across payor types.
(ii) Analyzing health outcomes and disparities.
(iii) Monitoring public health initiatives.
(iv) Supporting program development and evaluation
of those programs.
(v) Supporting health care quality reporting.
(vi) Supporting health equity efforts, including for
rural and underserved communities.
§ 3410. Public reports and databases.
(a) Public access.--The council shall release public reports
that provide information on:
(1) Consumer access to cost and quality comparisons to
facilitate shopping for health care services. Consumer access
shall include a data visualization tool that is user-
friendly, mobile-friendly and available in multiple
languages.
(2) Links to insurer patient portals to permit access by
covered individuals to policy-specific information.
(3) Analysis of trends in health care services
utilization, pricing, expenditures and cost drivers.
(4) Geographic and other variations in medical care and
costs throughout this Commonwealth, accounting for
differences in the classification and severity of illness of
patients and populations, as appropriate and feasible, and
taking into consideration the cost impact of subsidization
for uninsured and government-sponsored patients and teaching
expenses , when feasible with available data .
(5) Public data to support analysis of network adequacy,
claim authorizations and denials and premium rates.
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(b) Public report format.--The council must make public
reports available in accessible formats and languages as
follows:
(1) Text must be easy to understand and consumer-
friendly.
(2) Digital information must be in a digital, machine-
readable format that can be imported or read into a computer
system for further processing.
(3) Both text and digital information shall, to the
maximum extent possible, be accessible to individuals with
disabilities who may receive services from an entity that is
the subject of the report.
(4) The report shall be in English and , to the maximum
extent possible, in the languages spoken by individuals with
limited English proficiency who may receive services from an
entity that is the subject of the report.
(c) Public report timing.--Beginning September 1, 2026, and
each September 1 thereafter, the council shall issue public
reports regarding claims information relating to the prior
calendar year. The council may issue additional interim reports.
(d) Publicly accessible databases.--The council shall
develop and maintain databases to:
(1) Facilitate independent research.
(2) Facilitate understandable and reliable public access
that will enable consumers to assess quality and out-of-
pocket costs before receiving health care services.
§ 3411. Confidentiality and information sharing.
(a) Information sharing.--The council may only share data in
accordance with sections 3306 (relating to data dissemination
and publication), 3308 (relating to Right-to-Know Law and access
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to council data) and 3311 (relating to research and
demonstration projects). Except as provided under sections 3306,
3308, 3311 and subsections (c) and (d), data and information
produced by, obtained by or disclosed to the council or another
person in the course of the exercise of the council's powers and
duties under this chapter:
(1) Shall be confidential.
(2) Shall not be subject to subpoena.
(3) Shall not be subject to the act of February 14, 2008
(P.L.6, No.3), known as the Right-to-Know Law.
(4) Shall not be subject to discovery or admissible in
evidence in a private civil action.
(5) May not be made public by the council or any other
person.
(b) Personal health and financial information.--The council
shall protect personally identifiable health and financial
information collected or received under this chapter in
accordance with all applicable Federal and State laws and
regulations, including the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936),
the Health Information Technology for Economic and Clinical
Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and
implementing regulations.
(c) Data and information disclosure.-- Subject to the
confidentiality provisions of this section:
(1) The council shall share identifiable raw data and
information received to assist with the duties and
responsibilities or for compliance with Federal law, to the
following :
(i) The Insurance Department.
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(ii) The Department of Human Services.
(iii) The Department of Health.
(iv) The Department of Drug and Alcohol Programs.
(v) The Department of Aging.
(2) The council may share de-identified data and
information received with the Rural Health Redesign Center
Authority or a successor organization to assist in the
performance of the council's or authority's duties and
responsibilities.
(3) To the extent permitted by Federal and State law,
the council may receive and share de-identified data and
information, including the data and information enumerated
under section 3407 (relating to data collection) from other
jurisdictions, as follows:
(i) The council shall maintain as confidential data
or information received from regulatory agencies or law
enforcement officials in other jurisdictions in which the
data and information are confidential by law in those
jurisdictions. Data and information obtained by the
council under this paragraph shall be confidential as
provided under subsection (a).
(ii) The council may share de-identified data and
information with regulatory agencies or law enforcement
officials in other jurisdictions if, prior to receiving
the data or information, a regulatory agency or law
enforcement official demonstrates by written statement
the necessary authority and intent to provide to it the
same confidential treatment as required by this chapter.
(4) Data and information may be disclosed in only a de-
identified form, unless:
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(i) otherwise provided under this section; or
(ii) if the prior written authorization of the
person to which the information pertains has been
obtained.
(d) Public access.--
(1) The following are not subject to the confidentiality
provisions of this section:
(i) Public hearing testimony.
(ii) Public interest review final reports.
(iii) De-identified data and information collected
by the APCD that is contained within a public report or
database prepared or maintained under this chapter.
(2) The council shall post de-identified public reports
on the council's publicly accessible Internet website. The
council shall electronically provide notice of the posting of
a de-identified public report to the chair and minority chair
of:
(i) The Banking and Insurance Committee of the
Senate.
(ii) The Insurance Committee of the House of
Representatives.
(iii) The Health and Human Services Committee of the
Senate.
(iv) The Health Committee of the House of
Representatives.
(v) The Human Services Committee of the House of
Representatives.
(e) Construction.--Nothing in this section shall be
construed to prohibit the council from accessing data and
information n ecessary to carry out its responsibilities in
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accordance with law .
(f) Unauthorized use of data or information.--A person that
knowingly releases to an unauthorized person identifiable data
or information in violation of the provisions of this section
commits a misdemeanor of the first degree and shall, upon
conviction, be sentenced to pay a fine of up to $10,000 or to
imprisonment for not more than five years, or both. An
unauthorized person that knowingly receives or possesses the
identifiable data or information commits a misdemeanor of the
first degree.
(g) Unauthorized access to data or information.--If a person
inadvertently or by error gains access to data or information
that violates the provisions of this section, the data or
information must immediately be returned, without duplication,
to the council with proper notification of the error.
§ 3412. Grievances.
A data supplier may challenge a finding that its data failed
validation or may challenge a finding in a report using the
grievance procedures in section 3312 (relating to grievances and
grievance procedures) .
§ 3413. Enforcement and penalties.
(a) Compliance.--A payor or provider shall comply with any
request for data for the APCD that is necessary for the APCD
administrator to carry out the duties and responsibilities under
this chapter.
(b) General enforcement authority.--
(1) The Insurance Department, the Department of Health,
the Department of State and the Office of Attorney General
shall have authority to enforce the provisions of this
chapter against a data supplier identified in section 3407(a)
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(relating to data collection), other than a nongovernmental
payor that is licensed or otherwise subject to each entity's
respective regulatory authority. The appropriate authority
may investigate potential violations of this chapter based
upon information received from individuals, insurers,
providers and other sources in order to ensure compliance
with this chapter.
(2) Upon receipt or discovery of evidence of a potential
violation of this chapter, the council, the Insurance
Department, the Department of Health, the Department of State
or the Office of Attorney General may refer the matter for
enforcement to another agency identified in paragraph (1).
(3) Nothing in this chapter shall limit the ability of
the Insurance Department, the Department of Health, the
Department of State or the Office of Attorney General from
using information received under this chapter in the course
of its regulatory duties under any other law.
(c) Council enforcement.--In addition to the enforcement and
penalties under section 3310 (relating to enforcement and
penalty), the council may refer to another agency any instance
of noncompliance by a payor or provider under subsection (b)(2).
(d) Insurance Department enforcement.--In addition to
subsection (h):
(1) Upon satisfactory evidence of a violation of this
chapter by a person regulated by the Insurance Department,
the commissioner may, in the commissioner's discretion,
impose any of the penalties under section 5 of the act of
June 25, 1997 (P.L.295, No.29), known as the Pennsylvania
Health Care Insurance Portability Act.
(2) The enforcement remedies imposed under this section
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are in addition to any other remedies or penalties that may
be imposed under any other applicable statute, including the
act of July 22, 1974 (P.L.589, No.205), known as the Unfair
Insurance Practices Act.
(3) A violation of this chapter by an insurer is defined
to be an unfair method of competition and an unfair or
deceptive act or practice pursuant to the Unfair Insurance
Practices Act.
(e) Department of State enforcement.--A violation of this
chapter by a person licensed by the Department of State shall
constitute unprofessional conduct and subject the person to
disciplinary action under the applicable provisions of the
professional licensure statute under which the individual is
licensed.
(f) Department of Health enforcement.--In addition to
subsection (h), a violation of this chapter by a licensee of the
Department of Health shall be deemed a violation of and subject
the violating licensee to penalties provided for in the act of
July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
(g) Office of Attorney General enforcement.--In addition to
subsection (h) , a violation of this chapter is a violation of
the act of December 17, 1968 (P.L.1224, No.387), known as the
Unfair Trade Practices and Consumer Protection Law.
(h) Penalties.--
(1) In addition to the penalties under subsections (c),
(d), (e), (f) and (g), a person that violates this chapter is
subject to the following:
(i) Suspension, revocation or refusal to renew a
license or registration of the violating person.
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(ii) A cease and desist order.
(iii) Supervision, including through a consent
order.
(iv) A civil penalty in accordance with the
following:
(A) For a violation of this chapter for a person
that did not know nor reasonably should have known
was a violation, not more than $50,000 for each
violation.
(B) For a violation of this chapter for a person
that knew or reasonably should have known was a
violation, not more than $100,000 for each action in
willful violation of this chapter.
(C) In any event, not to exceed $250,000 per day
or $2,500,000 in the aggregate during a single
calendar year.
(v) For a violation of this chapter by a not-for-
profit entity, referral to the Office of Attorney General
for a review of its charitable exemption.
(2) Except as otherwise provided in this section, fines
collected under this chapter shall be deposited into the
General Fund.
(3) Two or more authorities may not impose a penalty on
the same insurer or provider for the same violation. A
department or office of the Commonwealth that imposes a
penalty under this chapter shall notify the council of the
imposition of a penalty.
(h.1) Deposit.--Penalties imposed under other statutes for a
violation of this chapter shall be deposited in the fund
specified in the professional licensure statute under which the
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disciplinary action is taken.
(i) Other remedies and penalties .--The enforcement remedies
and penalties imposed under this section are in addition to any
other remedies or penalties that may be imposed under any other
applicable statute.
(j) Administrative practice and procedure.--The
administrative provisions of this section shall be subject to 2
Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of
Commonwealth agencies). A party against whom penalties are
assessed in an administrative action may appeal to the
Commonwealth Court as provided in 2 Pa.C.S. Ch. 7 Subch. A
(relating to judicial review of Commonwealth agency action).
Section 2. This act shall take effect in 60 days.
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