House Bill 700 [continued]
1 and information so they can effectively manage their health.
2 (2) Ensuring that treatment decisions by health care
3 providers are based on evidence-based medicine.
4 (3) Ensuring that the patients get the care needed by
5 clarifying roles and tasks and ensuring that all who take
6 care of patients have centralized, up-to-date information
7 about the patient and that follow-up care is provided as a
8 standard procedure.
9 (4) Creating and maintaining a patient registry which is
10 the clinical information system that is the foundation for
11 successful integration of all the components of the model
12 because it permits tracking of individual patients and a
13 population of patients and helps guide the course of
14 treatment, anticipate problems and track problems.
15 (5) Engaging the entire organization in the chronic care
16 improvement effort.
17 (6) Forming alliances with state, local, business,
18 religious and other organizations to support or expand care
19 for those with chronic disease.
20 "Chronic disease." A disease that is long lasting or
21 recurrent, does not resolve spontaneously and is rarely
22 completely cured.
23 "Commissioner." The Insurance Commissioner of the
24 Commonwealth.
25 "Commonwealth average annual wage." The average annual wage
26 in this Commonwealth for a calendar year determined by the
27 Department of Labor and Industry under section 404(e)(2) of the
28 Unemployment Compensation Law.
29 "Community benefit." The community service requirement of an
30 institution of purely public charity under the Institutions of
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1 Purely Public Charity Act.
2 "Community Health Reinvestment Agreement." The Agreement on
3 Community Health Reinvestment entered into February 2, 2005, by
4 the Insurance Department and Capital BlueCross, Highmark Inc.,
5 Hospital Service Association of Northeastern Pennsylvania and
6 Independence Blue Cross and published in the Pennsylvania
7 Bulletin at 35 Pa.B. 4155 (July 23, 2005).
8 "Contractor." A person with whom the Insurance Department
9 has entered into a contract for the purposes of section 7202
10 (relating to Cover All Pennsylvanians health insurance program).
11 "Department." The Insurance Department of the Commonwealth.
12 "Drug price registry." The Pennsylvania Drug Retail Price
13 Registry established by the council under section 7209 (relating
14 to transparency in price and quality for consumers).
15 "Eligible employee enrollee." An individual who is 19 years
16 of age or older, is an employee of an eligible small low-wage
17 employer participant and has enrolled in CAP.
18 "Eligible individual." As follows:
19 (1) An individual who meets all of the following
20 criteria:
21 (i) Is at least 19 years of age but no older than 64
22 years of age.
23 (ii) Has been a resident of this Commonwealth at
24 least 90 days prior to enrollment in CAP.
25 (iii) Is ineligible to receive continuous
26 eligibility coverage under Title XIX or XXI of the Social
27 Security Act (49 Stat. 620, 42 U.S.C. § 301 et seq.),
28 except for benefits authorized under a waiver granted by
29 the United States Department of Health and Human Services
30 to implement CAP.
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1 (iv) Meets one of the following:
2 (A) Is currently enrolled in the health
3 investment insurance program established under
4 Chapter 13 of the Tobacco Settlement Act or is wait-
5 listed for the program on the effective date of this
6 section.
7 (B) Has a household income that is no greater
8 than 200% of the Federal poverty level at the time of
9 application and has not been covered by any health
10 insurance plan or program for at least 90 days
11 immediately preceding the date of application, except
12 that the foregoing 90-day period shall not apply to
13 an individual who meets one of the following:
14 (I) Is eligible to receive benefits under
15 the Unemployment Compensation Law.
16 (II) Was covered under a health insurance
17 plan or program provided by an employer but at
18 the time of application is no longer covered
19 because of a change in the individual's
20 employment status and is ineligible to receive
21 benefits under the Unemployment Compensation Law.
22 (III) Lost coverage as a result of divorce
23 or separation from a covered individual, the
24 death of a covered individual or a change in
25 employment status of a covered individual.
26 (IV) Is transferring from another
27 government-subsidized health insurance program,
28 including as a result of failure to meet income
29 eligibility requirements.
30 (C) Has a household income that is greater than
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1 200% of the Federal poverty level and has not been
2 covered by any health insurance plan or program
3 during the 180 days immediately preceding the date of
4 application, except that the foregoing 180-day period
5 shall not apply to an individual who meets one of the
6 following:
7 (I) Is eligible to receive benefits under
8 the Unemployment Compensation Law.
9 (II) Was covered under a health insurance
10 plan or program provided by an employer but at
11 the time of application is no longer covered
12 because of a change in the individual's
13 employment status and is ineligible to receive
14 benefits under the Unemployment Compensation Law.
15 (III) Lost coverage as a result of divorce
16 or separation from a covered individual, the
17 death of a covered individual or a change in
18 employment status of a covered individual.
19 (IV) Is transferring from another
20 government-subsidized health insurance program,
21 including as a result of failure to meet income
22 eligibility requirements.
23 (2) If an individual who otherwise meets the definition
24 in paragraph (1) is attending an institution of higher
25 education in this Commonwealth, he shall be required to meet
26 the domiciliary requirements of 22 Pa. Code Ch. 507 (relating
27 to finance and administration) prior to enrollment in CAP.
28 "Eligible individual enrollee." An eligible individual who
29 is enrolled in CAP. The term does not include an eligible
30 employee enrollee.
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1 "Eligible small low-wage employer." An employer that meets
2 all of the following:
3 (1) Has at least two, but not more than 50 full-time-
4 equivalent employees.
5 (2) Has not offered health care insurance through any
6 plan or program during the 180 days immediately preceding the
7 date of application for participation in CAP.
8 (3) Pays an average annual wage that is less than the
9 Commonwealth average annual wage.
10 (4) Will enroll in CAP at least 75% of all of its
11 employees who work 20 hours or more per week.
12 "Eligible small low-wage employer participant." An eligible
13 small low-wage employer who is participating in CAP.
14 "Employee." Any individual from whose wages an employer is
15 required under the Internal Revenue Code of 1986 (Public Law 99-
16 514, 26 U.S.C. § 1 et seq.) to withhold Federal income tax.
17 "Enrollee." An eligible employee enrollee or an eligible
18 individual enrollee, as the context may require.
19 "Fair share tax." The tax imposed under section 7203
20 (relating to fair share tax).
21 "Health benefit plan." An individual or group health
22 insurance policy, subscriber contract, certificate or plan which
23 provides health or sickness and accident coverage which is
24 offered by an insurer. The term shall not include any of the
25 following:
26 (1) An accident only policy.
27 (2) A limited benefit policy.
28 (3) A credit only policy.
29 (4) A long-term or disability income policy.
30 (5) A specified disease policy.
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