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§ 991.2194. Managed care plans participating in the Medical Assistance Program

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: November 2, 2006

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 2. Insurance Companies (Refs & Annos)
Article XXI. Quality Health Care Accountability and Protection (Refs & Annos)
(m) Miscellaneous
Effective: November 2, 2006
40 P.S. § 991.2194
§ 991.2194. Managed care plans participating in the Medical Assistance Program
Currentness
(a) The General Assembly finds that:
(1) Accessibility to health care services received by participants in the Commonwealth's medical assistance program must be maintained throughout this Commonwealth.
(2) The quality and continuity of these services must be assured in a manner that responsibly and effectively controls medical assistance costs.
(3) Managed care plans contracting with the Department of Public Welfare for purposes of participation in the medical assistance program have developed across this Commonwealth and provide vital health care services, including pharmaceuticals, to the medical assistance population of this Commonwealth.
(4) A review of the delivery of services provided by these managed care plans is necessary to enable the Department of Public Welfare, in consultation with the department, to formulate a strategy that properly utilizes cost control mechanisms that produce available savings to the Commonwealth if an effective and responsive health care network is to be maintained across this Commonwealth, especially due to continuing changes at the Federal level.
(b) The Legislative Budget and Finance Committee shall conduct a review of and issue a report on the delivery and quality of health care services provided through the current fee-for-service program as well as by managed care plans participating in the Commonwealth's medical assistance program. The report shall include the following for each service delivery system:
(1) Information regarding the number of medical assistance participants per service per county, separated by those served and those denied.
(2) The total cost or savings accrued to the Commonwealth itemized by county per service provided, including pharmaceuticals.
(3) Recommendations for revisions in practices used by the Department of Public Welfare to contract and provide for all health care services available through the medical assistance program.
(4) Any other recommendations that will promote medical assistance program savings.
(c) The Department of Public Welfare and all other affected State agencies shall cooperate fully with the Legislative Budget and Finance Committee in providing any and all information necessary to conduct its review and prepare its report.
(d) The Legislative Budget and Finance Committee shall report its findings and recommendations no later than March 1, 2007, to the Governor, the Secretary of Public Welfare, the Insurance Commissioner, the chairman and minority chairman of the Public Health and Welfare Committee of the Senate, the chairman and minority chairman of the Health and Human Services Committee of the House of Representatives, the chairman and minority chairman of the Banking and Insurance Committee of the Senate and the chairman and minority chairman of the Insurance Committee of the House of Representatives.
(e) For purposes of this section, “medical assistance” shall be defined as the State program of medical assistance established under the act of June 13, 1967 (P.L. 31, No. 21),1 known as the “Public Welfare Code.”

Credits

1921, May 17, P.L. 682, No. 284, § 2194, added 2006, Nov. 2, P.L. 1314, No. 136, § 2, imd. effective.

Footnotes

1
62 P.S. § 101 et seq.
40 P.S. § 991.2194, PA ST 40 P.S. § 991.2194
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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