2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 35 - HEALTH AND SAFETY › Chapter 33 - Health Care Cost Containment › Section 3304 - Powers and duties of council

§ 3304. Powers and duties of council.
(a) General powers.--
The council shall exercise all powers necessary and appropriate to carry out its duties, including the following:
(1) To employ an executive director, investigators and other staff necessary to comply with the provisions of this chapter and regulations promulgated thereunder, to employ or retain legal counsel and to engage professional consultants, as it deems necessary to the performance of its duties. Any consultants, other than sole source consultants, engaged by the council shall be selected in accordance with the provisions for contracting with vendors set forth in section 3314 (relating to contracts with vendors).
(2) To fix the compensation of all employees and to prescribe their duties. Notwithstanding the independence of the council under section 3303(a) (relating to Health Care Cost Containment Council), employees under this paragraph shall be deemed employees of the Commonwealth for the purposes of participation in the Pennsylvania Employee Benefit Trust Fund.
(3) To make and execute contracts and other instruments, including those for purchase of services and purchase or leasing of equipment and supplies, necessary or convenient to the exercise of the powers of the council. Any such contract shall be in accordance with the provision for contracting with vendors set forth in section 3314.
(4) To conduct examinations and investigations, to conduct audits, under the provisions of subsection (c), and to hear testimony and take proof, under oath or affirmation, at public or private hearings, on any matter necessary to its duties.
(5) To provide hospitals with individualized data on patient safety indicators under section 3305(c)(8) (relating to data submission and collection). The data shall be risk adjusted and made available to hospitals electronically and free of charge on a quarterly basis within 45 days of receipt of the corrected quarterly data from the hospitals. The data is intended to provide the patient safety committee of each hospital with information necessary to assist in conducting patient safety analysis.
(6) To do all things necessary to carry out its duties under the provisions of this chapter.
(b) Rules and regulations.--
(1) The council may promulgate rules and regulations as necessary and appropriate to implement this act.
(2) Regulations promulgated by the council shall be promulgated in accordance with the act of June 25, 1982 (P.L.633, No.181), known as the Regulatory Review Act.
(3) Rules and regulations in effect prior to the effective date of this section shall remain in effect.
(c) Audit powers.--
The council shall have the right to independently audit all information required to be submitted by data sources as needed to corroborate the accuracy of the submitted data, pursuant to the following:
(1) Audits of information submitted by providers or health care insurers shall be performed on a sample and issue-specific basis, as needed by the council, and shall be coordinated, to the extent practicable, with audits performed by the Commonwealth. All health care insurers and providers are required to make those books, records of accounts and any other data needed by the auditors available to the council at a convenient location within 30 days of written notification by the council.
(2) Audits of information submitted by purchasers shall be performed on a sample basis, unless there exists reasonable cause to audit specific purchasers, but in no case shall the council have the power to audit financial statements of purchasers.
(3) All audits performed by the council shall be performed at the expense of the council.
(4) The results of audits of providers or health care insurers shall be provided to the audited providers and health care insurers on a timely basis, not to exceed 30 days beyond presentation of audit findings to the council.
(d) General duties and functions.--
The council is hereby authorized to and shall perform the following duties and functions:
(1) Develop a computerized system for the collection, analysis and dissemination of data. The council may contract with a vendor who will provide data processing services. The council shall assure that the system will be capable of processing all data required to be collected under this chapter. Any vendor selected by the council shall be selected in accordance with the provisions of section 3314, and the vendor shall relinquish any and all proprietary rights or claims to the database created as a result of implementation of the data processing system.
(2) Establish a Pennsylvania Uniform Claims and Billing Form for all data sources and all providers, which shall be utilized and maintained by all data sources and all providers for all services covered under this chapter.
(3) (Reserved).
(4) Collect and disseminate data, as specified in sections 3305 and 3306 (relating to data dissemination and publication), and other information from data sources to which the council is entitled, prepared according to formats, time frames and confidentiality provisions as specified in sections 3305 and 3308 (relating to Right-to-Know Law and access to council data), and by the council.
(5) Adopt and implement a methodology to collect and disseminate data reflecting provider quality, provider service effectiveness, utilization and the cost of health care services under sections 3305 and 3306.
(6) Subject to the restrictions on access to raw data set forth in section 3308, issue special reports and make available raw data to a purchaser requesting it. Sale by a recipient or exchange or publication by a recipient, other than a purchaser, of council raw data to other parties without the express written consent of, and under terms approved by, the council shall be unauthorized use of data under section 3308(d).
(7) On an annual basis, publish in the Pennsylvania Bulletin a list of all the raw data reports it has prepared under section 3308(g) and a description of the data obtained through each computer-to-computer access it has provided under section 3308(g) and of the names of the parties to whom the council provided the reports or the computer-to-computer access during the previous month.
(8) Promote competition in the health care and health insurance markets.
(9) Assure that the use of council data does not raise access barriers to care.
(10) Provide information on the allowed and paid costs of medical services in terminology that may be reasonably understood by the average individual consumer of health care services. The council shall present the cost information in conjunction with information on quality of care delivery, if quality information is reasonably available to the council, so that the average individual consumer of health care services may use the information to inform purchasing decisions.
(11) In consultation with the Insurance Department and the Department of Health, make annual reports to the General Assembly on the rate of increase in the cost of health care in this Commonwealth, including, but not limited to, the following:
(i) The rate of increase in health insurance premiums in this Commonwealth.
(ii) Regional trends in cost of health care and health insurance premiums.
(iii) The effectiveness of the council in carrying out the legislative intent of this chapter.
(iv) The quality and effectiveness of health care and access to health care for all citizens of this Commonwealth.
(12) In the discretion of the council, make recommendations on the need for further health care cost containment legislation.
(13) Conduct studies and publish reports analyzing the effects that outpatient, alternative health care delivery systems have on health care costs. The systems shall include, but are not limited to, health maintenance organizations; preferred provider organizations; primary health care facilities; home health care; attendant care; ambulatory service facilities; freestanding emergency centers; birthing centers; and hospice care. The reports shall be submitted to the General Assembly and shall be made available to the public.
(14) Conduct studies and make reports concerning the utilization of experimental and nonexperimental transplant surgery and other highly technical and experimental procedures, including costs and mortality rates.
Cross References.
Section 3304 is referred to in sections 3305, 3308, 3312 of this title.