HB 1739 — 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
 1   Amending Title 35 (Health and Safety) of the Pennsylvania
 2      Consolidated Statutes, establishing an All Payor Claims
 3      Database; imposing duties on the Health Care Cost Containment
 4      Council; imposing penalties; and making an appropriation.
 5      The General Assembly of the Commonwealth of Pennsylvania
 6   hereby enacts as follows:
 7      Section 1.    Title 35 of the Pennsylvania Consolidated
 8   Statutes is amended by adding a chapter to read:
 9                                 CHAPTER 34
10                          ALL PAYOR CLAIMS DATABASE
11   Sec.
12   3401.   Scope of chapter.
13   3402.   Declaration of policy.
14   3403.   Definitions.
15   3404.   Establishment of database.
16   3405.   Contracting authority.
17   3406.   Advisory group.
18   3407.   Data collection.
19   3408.   Technical guidance.
 1   3409.   Data analysis and review.
 2   3410.   Public reports and databases.
 3   3411.   Confidentiality and information sharing.
 4   3412.   Grievances.
 5   3413.   Enforcement and penalties.
 6   § 3401.    Scope of chapter.
 7      This chapter relates to establishing an All Payor Claims
 8   Database.
 9   § 3402.    Declaration of policy.
10      The General Assembly finds and declares that the
11   establishment of an All Payor Claims Database would:
12             (1)   Facilitate the reporting of health care and health
13      quality data.
14             (2)   Promote the transparency of the price of health care
15      services through easily understandable and reliable public
16      reporting that will enable consumers to assess quality and
17      out-of-pocket costs before receiving health care services.
18             (3)   Support the regulation of health insurance and
19      health insurers by the Insurance Department.
20             (4)   Support payors for and providers of health care
21      services in assessing alternative payment models, including
22      value-based care models.
23             (5)   Assist regulators in analyzing health care spending
24      trends across different payor types, including Medicaid,
25      CHIP, Medicare and commercial insurance.
26             (6)   Support the analysis of market transactions
27      involving health care providers or payors.
28             (7)   Enable national, regional and state-by-state
29      comparisons of health care costs.
30   § 3403.    Definitions.

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 1      The following words and phrases when used in this chapter
 2   shall have the meanings given to them in this section unless the
 3   context clearly indicates otherwise:
 4      "All Payor Claims Database" or "APCD."   The database
 5   established under section 3404 (relating to establishment of
 6   database).
 7      "Commissioner."   The Insurance Commissioner of the
 8   Commonwealth.
 9      "Council."    The Health Care Cost Containment Council.
10      "Data."   Information submitted by a provider to a payor
11   relating to a claim for payment for a rendered health care
12   service.
13      "Elective payor."   A person not otherwise required to comply
14   with the insurance laws of this Commonwealth, including an
15   employer-sponsored self-funded health plan or a Taft-Hartley
16   trust health plan, that elects to voluntarily provide claims
17   data to the APCD within the time frames and in accordance with
18   procedures established by the council.
19      "Facility."   A health care setting or institution providing a
20   health care service, including:
21          (1)   A general, special, psychiatric, rehabilitation or
22      other hospital.
23          (2)   An ambulatory surgical facility.
24          (3)   A cancer treatment center.
25          (4)   A birth center.
26          (5)   A skilled nursing center.
27          (6)   An inpatient, outpatient or residential drug and
28      alcohol treatment facility.
29          (7)   A facility licensed by the Department of Human
30      Services' Office of Mental Health and Substance Abuse

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 1      Services.
 2          (8)     A laboratory, imaging, diagnostic or other
 3      outpatient medical service or testing facility.
 4          (9)     A provider office or clinic.
 5          (10)     An urgent care center.
 6          (11)     A stand-alone emergency care facility.
 7      "Health care service."    A treatment, admission, procedure,
 8   medical supply or equipment, pharmaceutical or other medical
 9   health or mental health service prescribed, rendered or
10   otherwise provided or proposed to be provided to an enrollee,
11   policyholder, certificate-holder, subscriber or other individual
12   who is entitled to receive health care services under a payor
13   payment arrangement in this Commonwealth for the diagnosis,
14   prevention, treatment, cure or relief of a health condition,
15   illness, injury or disease or functional limitation, including
16   emergency medical services as defined in section 8103 (relating
17   to definitions) and pharmacy benefits management as defined in
18   section 103 of the act of November 21, 2016 (P.L.1318, No.169),
19   known as the Pharmacy Audit Integrity and Transparency Act.
20      "Health insurer."    An entity licensed in this Commonwealth to
21   issue health insurance, subscriber contracts, certifications or
22   plans that provide medical or health care coverage by a provider
23   that is offered or governed under:
24          (1)     The act of May 17, 1921 (P.L.682, No.284), known as
25      The Insurance Company Law of 1921, including section 630 and
26      Article XXIV of that act.
27          (2)     The act of December 29, 1972 (P.L.1701, No.364),
28      known as the Health Maintenance Organization Act.
29          (3)     40 Pa.C.S. Chs. 61 (relating to hospital plan
30      corporations) and 63 (relating to professional health

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 1      services plan corporations).
 2      "Out-of-pocket costs."     Costs charged directly to an
 3   individual for services received by the individual or the
 4   individual's dependent, including deductibles, co-insurance,
 5   copayments and similar out-of-pocket expenses.
 6      "Payor."     A person that makes payments to facilities or
 7   providers for health care services rendered to an enrollee,
 8   policyholder, certificate holder, subscriber or other individual
 9   who is entitled to receive health care services under a health
10   insurance policy or other payor payment arrangement. The term
11   does not include an individual making a payment for out-of-
12   pocket costs.
13      "Payor payment arrangement."     A promise to pay for health
14   care services. The term does not include a health insurance
15   policy.
16      "Provider."    A person licensed, certified or otherwise
17   authorized or permitted by the laws of this Commonwealth or any
18   other state to provide or perform a health care service in the
19   ordinary course of business or practice and any other person
20   that furnishes, bills or is paid for a health care service in
21   the normal course of business, including, but not limited to, a
22   physician, podiatrist, optometrist, psychologist, physical
23   therapist, certified nurse practitioner, registered nurse, nurse
24   midwife, physician's assistant, chiropractor, dentist,
25   pharmacist, individual accredited or certified to provide
26   behavioral health services, a facility, nursing home, assisted
27   living provider, home health agency, medical equipment supplier,
28   emergency medical services agency or an individual providing an
29   emergency service on behalf of an emergency medical services
30   agency as those terms are defined in section 8103 (relating to

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 1   definitions) or any other health care provider as defined under
 2   45 CFR 160.103 (relating to definitions).
 3      "Purchaser."        A corporation, labor organization or other
 4   person that purchases benefits which provide health care
 5   services for employees or members, either through a health care
 6   insurer or by means of a self-funded program of benefits and a
 7   certified bargaining representative that represents a group or
 8   groups of employees for whom employers purchase a program of
 9   benefits which provide health care services. The term does not
10   include a health insurer.
11   § 3404.    Establishment of database.
12      (a)    Establishment.--The All Payor Claims Database shall be
13   established within 60 days of receipt of an appropriation under
14   subsection (b)(1). Prior to establishment of the APCD, the
15   commissioner may take action necessary to effectuate the prompt
16   establishment of the APCD, including, on behalf of the council,
17   to contract with one or more vendors for initial development of
18   the APCD.
19      (b)    Appropriations.--
20             (1)   The General Assembly:
21                   (i)    Shall appropriate not less than $4,000,000 for
22             the establishment of the APCD.
23                   (ii)   May annually appropriate General Fund money to
24             the council to pay for expenses related to the APCD.
25             (2)   If there is not sufficient funding to finance the
26      ongoing operations of the APCD, the council shall cease APCD
27      operations. If the APCD ceases to operate, the data submitted
28      shall be destroyed or returned to its original source.
29      (c)    Council duties.--The council shall:
30             (1)   Oversee the collection, aggregation and analysis of

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 1      data collected under sections 3407 (relating to data
 2      collection) and 3409 (relating to data analysis and review).
 3             (2)   Establish data access policies in accordance with
 4      sections 3410 (relating to public reports and databases) and
 5      3411 (relating to confidentiality and information sharing).
 6             (3)   Develop and implement data privacy and security
 7      protocols to safeguard against the misuse of data and ensure
 8      patient confidentiality and compliance with applicable
 9      Federal and State privacy laws and regulations, including the
10      Health Insurance Portability and Accountability Act of 1996
11      (Public Law 104-191, 110 Stat. 1936), the Health Information
12      Technology for Economic and Clinical Health Act (Public Law
13      111-5, 123 Stat. 226-279 and 467-496) and implementing
14      regulations.
15             (4)   Implement the reporting requirements in a cost-
16      effective and reasonable manner to produce reliable and
17      timely information.
18             (5)   Determine the reports and data on quality, health
19      outcomes, health disparities, cost, utilization and pricing
20      to be made available to the public.
21             (6)   Make recommendations for further study and data
22      collection to carry out the purposes of this chapter and
23      facilitate informed choices by consumers.
24   § 3405.    Contracting authority.
25      (a)    Procurements.--In addition to and consistent with any
26   contract entered into by the commissioner under section 3404(a)
27   (relating to establishment of database), the council shall
28   contract with one or more vendors for the development and
29   maintenance of the APCD.
30      (b)    Requirements and considerations.--

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 1          (1)   A vendor must satisfy the requirements of 42 CFR
 2    401.705 (relating to eligibility criteria for qualified
 3    entities) and 401.707 (relating to operating and governance
 4    requirements for qualified entities).
 5          (2)   The council shall consider all of the following in
 6    determining a vendor:
 7                (i)    The vendor's degree of experience in health care
 8          data collection, analysis, analytics and security.
 9                (ii)    Whether the vendor has a long-term self-
10          sustainable financial model.
11                (iii)    The vendor's experience in convening and
12          effectively engaging stakeholders to develop reports,
13          especially among groups of health providers, health
14          insurers, carriers and self-insured purchasers.
15                (iv)    The vendor's experience in meeting budget and
16          time lines for report generation.
17                (v)    The vendor's ability to combine cost and quality
18          data to assess total cost of care.
19    (c)   Use of experts.--
20          (1)   The council may contract with competent experts,
21    including legal, actuarial or economic experts, to assist the
22    council in the review of any matter within the scope of this
23    chapter, including auditing the accuracy of data submitted.
24    The council may bill reasonable and necessary costs for the
25    services of an expert to:
26                (i)    the nongovernmental payors on a pro rata basis
27          based on the number of covered lives in proportion to all
28          covered lives by those nongovernmental payors; or
29                (ii)    a data supplier if the services are particular
30          as to that data supplier, other than a governmental

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 1             payor.
 2             (2)   Within 30 days of its receipt of a bill for the
 3      services, the payor shall make payment directly to the expert
 4      and shall provide confirmation of payment to the council.
 5      (d)    Procurements within one year.--The contracts entered
 6   into under this section shall be subject to the requirements of
 7   section 3314 (relating to contracts with vendors) for one year
 8   after the effective date of this subsection.
 9   § 3406.    Advisory group.
10      In addition to the advisory groups established under section
11   3303(g) and (h) (relating to Health Care Cost Containment
12   Council), the council shall establish an APCD advisory group
13   that shall include the Secretary of Health, the Secretary of
14   Human Services and the commissioner, who shall be chairman. The
15   duties of the APCD advisory group shall include, but not be
16   limited to, advising the council on the following:
17             (1)   The data elements to be collected and methods of
18      collection.
19             (2)   The reporting formats for data submitted.
20             (3)   The use and reporting of any data submitted.
21             (4)   Coordination of public and private health care
22      quality and performance measures.
23             (5)   The utilization of publicly available data in
24      combination with data collected by the APCD, where
25      appropriate.
26             (6)   The types of reports to be made available to the
27      public.
28             (7)   The types of databases to be maintained to
29      facilitate independent research and consumer usability.
30   § 3407.    Data collection.

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 1      (a)   Data suppliers.--The following persons shall submit data
 2   to the council upon request:
 3            (1)   Nongovernmental payors, including:
 4                  (i)    Insurers, including health insurers, for
 5            policies subject to regulation by the Insurance
 6            Department under which a claim described in subsection
 7            (b) is paid, including policies that provide the
 8            following types of coverage:
 9                         (A)   Health insurance.
10                         (B)   Accident only.
11                         (C)   Credit only.
12                         (D)   Long-term care or disability income.
13                         (E)   Specified disease.
14                         (F)   Medicare supplement.
15                         (G)   Fixed indemnity.
16                         (H)   Dental only.
17                         (I)   Vision only.
18                         (J)   Workers' compensation.
19                         (K)   Automobile medical payment.
20                         (L)   Any other coverage policy regulated by the
21                  Insurance Department under which health care claims
22                  may be paid.
23                  (ii)    Issuers or administrators of coverage under
24            Medicare Advantage Part C under Title XVIII of the Social
25            Security Act (49 Stat. 620, 42 U.S.C. § 1395 et seq.),
26            insofar as not prohibited by Federal law.
27                  (iii)    Third-party administrators paying claims on
28            behalf of health plans in this Commonwealth, for:
29                         (A)   Fully insured health plans.
30                         (B)   Elective payors, at the direction of the

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 1              elective payor.
 2        (2)   Governmental payors, including:
 3              (i)    The Commonwealth's Medical Assistance program
 4        established under the act of June 13, 1967 (P.L.31,
 5        No.21), known as the Human Services Code, including
 6        entities contracted to provide services under the
 7        program.
 8              (ii)    The Children's Health Insurance Program under
 9        Article XXIII-A of the act of May 17, 1921 (P.L.682,
10        No.284), known as The Insurance Company Law of 1921,
11        including entities contracted to provide services under
12        the program.
13              (iii)    Health care coverage provided by the
14        Commonwealth, a county, a city or other State or local
15        governmental entity or an agency, subdivision or
16        department of a governmental entity, including:
17                     (A)   A corporation or other arrangement organized
18              by the entity for the provision of health care
19              coverage and subject to control by the entity or an
20              instrumentality of the entity.
21                     (B)   The Pennsylvania Employee Benefit Trust Fund
22              for active and retired employees.
23              (iv)    Issuers or administrators of coverage under
24        Medicare Parts A and B under Title XVIII of the Social
25        Security Act, insofar as not prohibited by Federal law.
26              (v)    Issuers or administrators of policies under
27        which benefits are provided by the Federal Government to
28        active or former military personnel and their dependents,
29        insofar as not prohibited by Federal law.
30              (vi)    Issuers or administrators of a health care plan

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 1            provided through the Federal Employees Health Benefits
 2            Program established under 5 U.S.C. Ch. 89 (relating to
 3            health insurance), insofar as not prohibited by Federal
 4            law.
 5            (3)    Providers.
 6            (4)    Facilities.
 7      (b)   Claims data subject to collection.--The data provided
 8   under subsection (a) must be provided for at least the
 9   following:
10            (1)    Types of claims:
11                   (i)    Medical health.
12                   (ii)    Mental health.
13                   (iii)    Dental health.
14                   (iv)    Substance use disorders.
15                   (v)    Emergency services, including transport and
16            care.
17                   (vi)    Pharmaceuticals.
18                   (vii)    Durable medical equipment.
19            (2)    Types of providers:
20                   (i)    Inpatient.
21                   (ii)    Outpatient, including at ambulatory surgical
22            facilities.
23                   (iii)    Primary.
24                   (iv)    Specialist.
25                   (v)    Pharmacy.
26      (c)   Categories of data.--The council shall collect data as
27   to each type of claim identified in subsection (b) to include:
28            (1)    Demographic information, including the patient's
29      gender, age and geographic area of residency.
30            (2)    Information relating to an individual episode of

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 1      care, including the date and time of the patient's admission
 2      and discharge, the identity of the health care services
 3      provider and the location and type of facility, such as a
 4      hospital, office or clinic, where the service was provided.
 5             (3)   Information describing the nature of health care
 6      services provided to the patient in connection with the
 7      encounter, visit or service, including diagnosis codes.
 8             (4)   Health insurance product type, such as HMO or PPO.
 9             (5)   Pricing and payment information, including a
10      facility's or provider's billed and accepted amounts, a
11      payor's allowed and paid amounts and a consumer's out-of-
12      pocket costs.
13             (6)   Service frequency data, including admission and re-
14      admission and visit frequency data.
15             (7)   Patient engagement and compliance data, including
16      medication adherence.
17      (d)    Format of data submission.--The council is authorized to
18   collect, and data suppliers are required to submit upon request
19   of the council, all data required in this section in a uniform
20   format.
21      (e)    Timing of data submission.--Each data supplier shall
22   timely submit all data required in this section in accordance
23   with the following:
24             (1)   On or before the 15th day of each month, each data
25      supplier shall submit data relating to the prior month.
26             (2)   On or before April 1 of each year following the
27      effective date of this paragraph, each data supplier shall
28      submit an annual report compiling the data relating to the
29      prior calendar year.
30      (f)    Submission.--Unless modified or supplemented by

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 1   regulations promulgated under this chapter, in instances where
 2   more than one entity is involved in the administration of a
 3   policy, a health insurer shall be responsible for submitting the
 4   claims data for policies that the health insurer has written,
 5   and the third-party administrator shall be responsible for
 6   submitting claims data for elective payor plans that it
 7   administers.
 8      (g)    Administrative penalties.--
 9             (1)   A data supplier that fails to submit data shall be
10      subject to an administrative penalty of $1,000 for each day
11      that the required data is not provided in accordance with
12      this section.
13             (2)   A data supplier that fails to correct data as
14      required under subsection (h)(2) within 30 days of the
15      request to correct the data shall be subject to an
16      administrative penalty of $1,000 for each day that the
17      required corrected data is not provided in accordance with
18      this section.
19             (3)   A data supplier may be subject to the administrative
20      penalties in paragraph (1) and (2).
21      (h)    Review and correction.--
22             (1)   The council's vendor shall review and validate all
23      data submitted within 60 days of receipt.
24             (2)   If data fails validation, the council's vendor shall
25      direct a data source to correct the data within 30 days.
26   § 3408.    Technical guidance.
27      (a)    Content.--
28             (1)   The council shall publish technical guidance, in
29      accordance with subsection (b), to establish uniform
30      submission formats, coding systems and other technical

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 1      specifications necessary to render the incoming data
 2      substantially valid, consistent, compatible and manageable
 3      using electronic data processing according to data submission
 4      schedules.
 5            (2)   Technical guidance shall avoid, to the extent
 6      possible, submission of identical data from more than one
 7      data supplier. The uniform submission formats, coding systems
 8      and other technical specifications may be established by the
 9      council pursuant to its authority under section 3304
10      (relating to power and duties of council). If payor data is
11      requested by the council, it shall, to the extent possible,
12      be obtained from primary payor sources. The council shall not
13      require a data supplier to contract with any specific vendor
14      for submission of any specific data elements to the council.
15      (b)   Publication and notice.--The council shall publish
16   technical guidance under this subsection not more than once each
17   year in accordance with the following:
18            (1)   The council shall publish draft and final technical
19      guidance by transmitting notice to the Legislative Reference
20      Bureau for publication in the next available issue of the
21      Pennsylvania Bulletin and by:
22                  (i)    Posting the technical guidance on the council's
23            publicly accessible Internet website.
24                  (ii)   Electronically sending notice to the chair and
25            minority chair of the Banking and Insurance Committee of
26            the Senate, the chair and minority chair of the Insurance
27            Committee of the House of Representatives, the chair and
28            minority chair of the Health and Human Services Committee
29            of the Senate and the chair and minority chair of the
30            Health Committee of the House of Representatives.

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 1                   (iii)    Electronically sending notice to a contact
 2             person or electronic mailing address as identified by the
 3             person, to the council, of the Hospital Association of
 4             Pennsylvania or a successor organization, the
 5             Pennsylvania Medical Society, or a successor organization
 6             and all health insurers offering comprehensive health
 7             insurance to the individual in this Commonwealth.
 8             (2)   There shall be a 60-day comment period after
 9      publication of draft technical guidance.
10             (3)   Final technical guidance shall be published in
11      accordance with paragraph (1) and may not take effect until
12      30 days after the end of the comment period under paragraph
13      (2).
14   § 3409.    Data analysis and review.
15      The council and a vendor retained under section 3405
16   (relating to contracting authority) shall provide access to the
17   data and provide data analysis upon request to:
18             (1)   The Insurance Department, for use in at least the
19      following:
20                   (i)    Product regulation, including form and rate
21             review.
22                   (ii)     Network adequacy regulation.
23                   (iii)    Market actions, investigations, examinations
24             and other enforcement actions.
25                   (iv)    Promoting price and quality transparency for
26             consumers.
27                   (v)    Mediating contract negotiations between
28             providers and payors.
29             (2)   The Department of Health and the Department of Human
30      Services, for use in at least the following:

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 1                   (i)     Analyzing health care spending trend analysis,
 2             including across payor types.
 3                   (ii)    Analyzing health outcomes and disparities.
 4                   (iii)    Monitoring public health initiatives.
 5                   (iv)    Supporting program development and evaluation
 6             of those programs.
 7                   (v)    Supporting health care quality reporting.
 8                   (vi)    Supporting health equity efforts, including for
 9             rural and underserved communities.
10   § 3410.    Public reports and databases.
11      (a)    Public access.--The council shall release public reports
12   that provide information on:
13             (1)   Consumer access to cost and quality comparisons to
14      facilitate shopping for health care services. Consumer access
15      shall include a data visualization tool that is user-
16      friendly, mobile-friendly and available in multiple
17      languages.
18             (2)   Links to insurer patient portals to permit access by
19      covered individuals to policy-specific information.
20             (3)   Analysis of trends in health care services
21      utilization, pricing, expenditures and cost drivers.
22             (4)   Geographic and other variations in medical care and
23      costs throughout this Commonwealth, accounting for
24      differences in the classification and severity of illness of
25      patients and populations, as appropriate and feasible, and
26      taking into consideration the cost impact of subsidization
27      for uninsured and government-sponsored patients and teaching
28      expenses, when feasible with available data.
29             (5)   Public data to support analysis of network adequacy,
30      claim authorizations and denials and premium rates.

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 1      (b)     Public report format.--The council must make public
 2   reports available in accessible formats and languages as
 3   follows:
 4             (1)   Text must be easy to understand and consumer-
 5      friendly.
 6             (2)   Digital information must be in a digital, machine-
 7      readable format that can be imported or read into a computer
 8      system for further processing.
 9             (3)   Both text and digital information shall, to the
10      maximum extent possible, be accessible to individuals with
11      disabilities who may receive services from an entity that is
12      the subject of the report.
13             (4)   The report shall be in English and, to the maximum
14      extent possible, in the languages spoken by individuals with
15      limited English proficiency who may receive services from an
16      entity that is the subject of the report.
17      (c)     Public report timing.--Beginning September 1, 2026, and
18   each September 1 thereafter, the council shall issue public
19   reports regarding claims information relating to the prior
20   calendar year. The council may issue additional interim reports.
21      (d)     Publicly accessible databases.--The council shall
22   develop and maintain databases to:
23             (1)   Facilitate independent research.
24             (2)   Facilitate understandable and reliable public access
25      that will enable consumers to assess quality and out-of-
26      pocket costs before receiving health care services.
27   § 3411.    Confidentiality and information sharing.
28      (a)     Information sharing.--The council may only share data in
29   accordance with sections 3306 (relating to data dissemination
30   and publication), 3308 (relating to Right-to-Know Law and access

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 1   to council data) and 3311 (relating to research and
 2   demonstration projects). Except as provided under sections 3306,
 3   3308, 3311 and subsections (c) and (d), data and information
 4   produced by, obtained by or disclosed to the council or another
 5   person in the course of the exercise of the council's powers and
 6   duties under this chapter:
 7            (1)   Shall be confidential.
 8            (2)   Shall not be subject to subpoena.
 9            (3)   Shall not be subject to the act of February 14, 2008
10      (P.L.6, No.3), known as the Right-to-Know Law.
11            (4)   Shall not be subject to discovery or admissible in
12      evidence in a private civil action.
13            (5)   May not be made public by the council or any other
14      person.
15      (b)   Personal health and financial information.--The council
16   shall protect personally identifiable health and financial
17   information collected or received under this chapter in
18   accordance with all applicable Federal and State laws and
19   regulations, including the Health Insurance Portability and
20   Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936),
21   the Health Information Technology for Economic and Clinical
22   Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and
23   implementing regulations.
24      (c)   Data and information disclosure.--Subject to the
25   confidentiality provisions of this section:
26            (1)   The council shall share identifiable raw data and
27      information received to assist with the duties and
28      responsibilities or for compliance with Federal law, to the
29      following:
30                  (i)   The Insurance Department.

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 1              (ii)    The Department of Human Services.
 2              (iii)    The Department of Health.
 3              (iv)    The Department of Drug and Alcohol Programs.
 4              (v)    The Department of Aging.
 5        (2)   The council may share de-identified data and
 6    information received with the Rural Health Redesign Center
 7    Authority or a successor organization to assist in the
 8    performance of the council's or authority's duties and
 9    responsibilities.
10        (3)   To the extent permitted by Federal and State law,
11    the council may receive and share de-identified data and
12    information, including the data and information enumerated
13    under section 3407 (relating to data collection) from other
14    jurisdictions, as follows:
15              (i)    The council shall maintain as confidential data
16        or information received from regulatory agencies or law
17        enforcement officials in other jurisdictions in which the
18        data and information are confidential by law in those
19        jurisdictions. Data and information obtained by the
20        council under this paragraph shall be confidential as
21        provided under subsection (a).
22              (ii)    The council may share de-identified data and
23        information with regulatory agencies or law enforcement
24        officials in other jurisdictions if, prior to receiving
25        the data or information, a regulatory agency or law
26        enforcement official demonstrates by written statement
27        the necessary authority and intent to provide to it the
28        same confidential treatment as required by this chapter.
29        (4)   Data and information may be disclosed in only a de-
30    identified form, unless:

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 1                  (i)    otherwise provided under this section; or
 2                  (ii)    if the prior written authorization of the
 3            person to which the information pertains has been
 4            obtained.
 5      (d)   Public access.--
 6            (1)   The following are not subject to the confidentiality
 7      provisions of this section:
 8                  (i)    Public hearing testimony.
 9                  (ii)    Public interest review final reports.
10                  (iii)    De-identified data and information collected
11            by the APCD that is contained within a public report or
12            database prepared or maintained under this chapter.
13            (2)   The council shall post de-identified public reports
14      on the council's publicly accessible Internet website. The
15      council shall electronically provide notice of the posting of
16      a de-identified public report to the chair and minority chair
17      of:
18                  (i)    The Banking and Insurance Committee of the
19            Senate.
20                  (ii)    The Insurance Committee of the House of
21            Representatives.
22                  (iii)    The Health and Human Services Committee of the
23            Senate.
24                  (iv)    The Health Committee of the House of
25            Representatives.
26                  (v)    The Human Services Committee of the House of
27            Representatives.
28      (e)   Construction.--Nothing in this section shall be
29   construed to prohibit the council from accessing data and
30   information necessary to carry out its responsibilities in

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 1   accordance with law.
 2      (f)    Unauthorized use of data or information.--A person that
 3   knowingly releases to an unauthorized person identifiable data
 4   or information in violation of the provisions of this section
 5   commits a misdemeanor of the first degree and shall, upon
 6   conviction, be sentenced to pay a fine of up to $10,000 or to
 7   imprisonment for not more than five years, or both. An
 8   unauthorized person that knowingly receives or possesses the
 9   identifiable data or information commits a misdemeanor of the
10   first degree.
11      (g)    Unauthorized access to data or information.--If a person
12   inadvertently or by error gains access to data or information
13   that violates the provisions of this section, the data or
14   information must immediately be returned, without duplication,
15   to the council with proper notification of the error.
16   § 3412.    Grievances.
17      A data supplier may challenge a finding that its data failed
18   validation or may challenge a finding in a report using the
19   grievance procedures in section 3312 (relating to grievances and
20   grievance procedures).
21   § 3413.    Enforcement and penalties.
22      (a)    Compliance.--A payor or provider shall comply with any
23   request for data for the APCD that is necessary for the APCD
24   administrator to carry out the duties and responsibilities under
25   this chapter.
26      (b)    General enforcement authority.--
27             (1)   The Insurance Department, the Department of Health,
28      the Department of State and the Office of Attorney General
29      shall have authority to enforce the provisions of this
30      chapter against a data supplier identified in section 3407(a)

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 1      (relating to data collection), other than a nongovernmental
 2      payor that is licensed or otherwise subject to each entity's
 3      respective regulatory authority. The appropriate authority
 4      may investigate potential violations of this chapter based
 5      upon information received from individuals, insurers,
 6      providers and other sources in order to ensure compliance
 7      with this chapter.
 8            (2)   Upon receipt or discovery of evidence of a potential
 9      violation of this chapter, the council, the Insurance
10      Department, the Department of Health, the Department of State
11      or the Office of Attorney General may refer the matter for
12      enforcement to another agency identified in paragraph (1).
13            (3)   Nothing in this chapter shall limit the ability of
14      the Insurance Department, the Department of Health, the
15      Department of State or the Office of Attorney General from
16      using information received under this chapter in the course
17      of its regulatory duties under any other law.
18      (c)   Council enforcement.--In addition to the enforcement and
19   penalties under section 3310 (relating to enforcement and
20   penalty), the council may refer to another agency any instance
21   of noncompliance by a payor or provider under subsection (b)(2).
22      (d)   Insurance Department enforcement.--In addition to
23   subsection (h):
24            (1)   Upon satisfactory evidence of a violation of this
25      chapter by a person regulated by the Insurance Department,
26      the commissioner may, in the commissioner's discretion,
27      impose any of the penalties under section 5 of the act of
28      June 25, 1997 (P.L.295, No.29), known as the Pennsylvania
29      Health Care Insurance Portability Act.
30            (2)   The enforcement remedies imposed under this section

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 1      are in addition to any other remedies or penalties that may
 2      be imposed under any other applicable statute, including the
 3      act of July 22, 1974 (P.L.589, No.205), known as the Unfair
 4      Insurance Practices Act.
 5            (3)   A violation of this chapter by an insurer is defined
 6      to be an unfair method of competition and an unfair or
 7      deceptive act or practice pursuant to the Unfair Insurance
 8      Practices Act.
 9      (e)   Department of State enforcement.--A violation of this
10   chapter by a person licensed by the Department of State shall
11   constitute unprofessional conduct and subject the person to
12   disciplinary action under the applicable provisions of the
13   professional licensure statute under which the individual is
14   licensed.
15      (f)   Department of Health enforcement.--In addition to
16   subsection (h), a violation of this chapter by a licensee of the
17   Department of Health shall be deemed a violation of and subject
18   the violating licensee to penalties provided for in the act of
19   July 19, 1979 (P.L.130, No.48), known as the Health Care
20   Facilities Act.
21      (g)   Office of Attorney General enforcement.--In addition to
22   subsection (h), a violation of this chapter is a violation of
23   the act of December 17, 1968 (P.L.1224, No.387), known as the
24   Unfair Trade Practices and Consumer Protection Law.
25      (h)   Penalties.--
26            (1)   In addition to the penalties under subsections (c),
27      (d), (e), (f) and (g), a person that violates this chapter is
28      subject to the following:
29                  (i)   Suspension, revocation or refusal to renew a
30            license or registration of the violating person.

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 1                (ii)    A cease and desist order.
 2                (iii)    Supervision, including through a consent
 3          order.
 4                (iv)    A civil penalty in accordance with the
 5          following:
 6                       (A)   For a violation of this chapter for a person
 7                that did not know nor reasonably should have known
 8                was a violation, not more than $50,000 for each
 9                violation.
10                       (B)   For a violation of this chapter for a person
11                that knew or reasonably should have known was a
12                violation, not more than $100,000 for each action in
13                willful violation of this chapter.
14                       (C)   In any event, not to exceed $250,000 per day
15                or $2,500,000 in the aggregate during a single
16                calendar year.
17                (v)    For a violation of this chapter by a not-for-
18          profit entity, referral to the Office of Attorney General
19          for a review of its charitable exemption.
20          (2)   Except as otherwise provided in this section, fines
21      collected under this chapter shall be deposited into the
22      General Fund.
23          (3)   Two or more authorities may not impose a penalty on
24      the same insurer or provider for the same violation. A
25      department or office of the Commonwealth that imposes a
26      penalty under this chapter shall notify the council of the
27      imposition of a penalty.
28      (h.1)   Deposit.--Penalties imposed under other statutes for a
29   violation of this chapter shall be deposited in the fund
30   specified in the professional licensure statute under which the

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 1   disciplinary action is taken.
 2      (i)   Other remedies and penalties.--The enforcement remedies
 3   and penalties imposed under this section are in addition to any
 4   other remedies or penalties that may be imposed under any other
 5   applicable statute.
 6      (j)   Administrative practice and procedure.--The
 7   administrative provisions of this section shall be subject to 2
 8   Pa.C.S. Ch. 5 Subch. A (relating to practice and procedure of
 9   Commonwealth agencies). A party against whom penalties are
10   assessed in an administrative action may appeal to the
11   Commonwealth Court as provided in 2 Pa.C.S. Ch. 7 Subch. A
12   (relating to judicial review of Commonwealth agency action).
13      Section 2.   This act shall take effect in 60 days.




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