Pennsylvania HB 1739: An Act providing for direct primary care, medical service agreements and insurance, for medical service agreement requirements, for use of health savings accounts or flexible spending accounts and for use of other health care practitioners.

Bill Text

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