Pennsylvania Act 1990-81 — HEALTH CARE PRACTITIONERS MEDICARE FEE CONTROL ACT

Act text

HEALTH CARE PRACTITIONERS MEDICARE FEE CONTROL ACT
                  Act of Jul. 10, 1990, P.L. 352, No. 81              Cl. 63
                                  AN ACT

     Prohibiting health care practitioners from balance billing for
        services to certain patients.

        The General Assembly of the Commonwealth of Pennsylvania
     hereby enacts as follows:

     Section 1.  Short title.
        This act shall be known and may be cited as the Health Care
     Practitioners Medicare Fee Control Act.
     Section 2.  Purposes.
        (a)  Legislative finding.--The General Assembly finds that
     there exists in this Commonwealth a major crisis because of the
     continuing escalation of costs for health care services. Because
     of the continuing escalation of costs, an increasingly large
     number of Pennsylvania citizens have severely limited access to
     appropriate and timely health care. Senior citizens and the
     disabled are disadvantaged by the continuing escalation of costs
     for health care services. Increasing costs are also undermining
     the quality of health care services currently being provided.
     Further, the continuing escalation is negatively affecting the
     economy of this Commonwealth and is restricting new economic
     growth and impeding the creation of new job opportunities in
     this Commonwealth.
        (b)  Declaration of policy.--The General Assembly declares
     its policy to be that, in accordance with the provisions of this
     act, providers of health care services should not charge or
     collect from a beneficiary of health insurance under Title XVIII
     of the Social Security Act (Public Law 74-271, 42 U.S.C. § 301
     et seq.), known as the Medicare Program, an amount in excess of
     the reasonable charge for the service provided, as determined by
     the United States Secretary of Health and Human Services.
     Section 3.  Definitions.
        The following words and phrases when used in this act shall
     have the meanings given to them in this section unless the
     context clearly indicates otherwise:
        "Balance billing."  To charge or collect from a beneficiary
     of health insurance under Title XVIII of the Social Security Act
     (Public Law 74-271, 42 U.S.C. § 301 et seq.), known as the
     Medicare Program, an amount in excess of the reasonable charge
     for the service provided, as determined by the United States
     Secretary of Health and Human Services.
        "Healing arts."  The science and skill of diagnosis,
     prevention or treatment, in any manner whatsoever, of disease or
     any ailment of the human body.
        "Health care practitioner."  An individual who is authorized
     to practice some component of the healing arts by a license,
     permit, certificate or registration issued by a Commonwealth
     licensing agency or board. The term includes, but is not limited
     to, a medical doctor, an osteopathic physician, a chiropractor,
     a dentist, an optometrist, a pharmacist, a physical therapist, a
     podiatrist, a professional nurse and a psychologist.
     Section 4.  Balance billing by health care practitioners
                    prohibited.
        It shall be unlawful for any health care practitioner, or any
     primary health center, corporation, facility, institution or
     other entity that employs a health care practitioner, to balance
     bill.

     Section 5.  Penalties and procedure.
        (a)  General penalties.--If a person violates section 4, the
     licensing board of the Bureau of Professional and Occupational
     Affairs under which the violator is licensed shall do the
     following:
            (1)  Publicly reprimand the violator.
            (2)  Order the violator to repay the victim the amount of
        excess payments made and received, plus interest on that
        amount at the maximum legal rate from the date payment was
        made until the date repayment is made.
        (b)  Additional violations.--If a person violates section 4
     more than once, the penalties set forth in subsection (a) shall
     again be ordered. In addition, the following penalties shall be
     imposed:
            (1)  For a second violation, a fine of $2,000.
            (2)  For a third violation, a fine of $5,000.
            (3)  For a fourth or subsequent violation, a fine of
        $1,000 more than the last fine imposed.
        (c)  Disposition of fines collected.--Fines collected under
     this section shall be deposited into the General Fund.
        (d)  Procedure.--Before a penalty may be imposed under this
     section, a complaint shall be filed against the health care
     practitioner and notice of and an opportunity for a hearing
     shall be given. Either party to the complaint may appeal to the
     Commonwealth Court from an adjudication of the licensing board
     under 2 Pa.C.S. (relating to administrative law and procedure).
        (e)  Exceptions.--No penalty imposed under this section shall
     be considered cause to withhold, suspend or revoke the license
     of a health care practitioner by a licensing board.
     Section 6.  Notice to Medicare beneficiaries.
        (a)  Practitioner's duty.--A sign which sets forth the
     following shall be posted by licensed health care practitioners
     who treat Medicare beneficiaries:
            (1)  The rights of Medicare patients under this act.
            (2)  The identification of the Department of State as the
        proper State agency to receive patients' complaints relating
        to balance billing prohibited under this act.
            (3)  The address and telephone number of the Department
        of State.
        (b)  Distribution of signs.--The signs posted by licensed
     health care practitioners, in accordance with subsection (a),
     shall be composed, printed and distributed by the Bureau of
     Professional and Occupational Affairs of the Department of
     State. Distribution shall be to all health practitioners who
     treat Medicare beneficiaries.
        (c)  Duty in the case of bilingual patients.--If a health
     care practitioner treats Medicare beneficiaries whose primary
     language skill is in a language other than English, the
     practitioner shall notify the Bureau of Professional and
     Occupational Affairs, which shall provide the practitioner with
     a sign setting forth the information required under subsection
     (a) in the appropriate language.
     Section 7.  Effective date.
        This act shall take effect in 60 days.