Section 3801.509 - Filing of provider contractsChapter 5 of the Accident and Health filing Reform Act [40 P.S. §§ 3801.501 to 3801.514] effective upon publication of notice under 40 P.S. § 3801.5103.
(a) Filing and review process.--Provider contracts shall be filed by insurers and reviewed by the department as follows:(1) Provider contracts shall be filed with the department no later than 30 days prior to the effective date specified in the contract.(2) Provider contracts shall become effective unless disapproved within 30 days following: (i) the expiration of the public comment period established by the commissioner under section 511 ; or(ii) receipt of the filing by the department if no public comment is established.(3) The department may disapprove a provider contract whenever it is determined that the contract: (i) provides for excessive payments;(ii) fails to include reasonable incentives for cost control;(iii) contributes to the escalation of the cost of providing health care services; or(iv) does not provide for the realization of potential and achieved savings under the contract by insureds and subscribers.(b) Review of the disapproval.--Upon disapproval of a provider contract under this section, the insurer may seek review of the disapproval as provided in section 507 . (c) Payment rates and fee information.--Provider contracts filed under this section need not contain payment rates and fees unless requested by the department. Payment rates and fees requested by the department shall be given confidential treatment, are not subject to subpoena and may not be made public by the department, except that the payment rates and fee information may be disclosed to the insurance department of another state or to a law enforcement official of this State or any other state or agency of the Federal Government at any time so long as the agency or office receiving the information agrees in writing to hold it confidential and in a manner consistent with this chapter.(d) Disapproval of existing contract.--If, at any time, the commissioner determines that a provider contract which has become effective under this section violates the standards as provided in subsection (a)(3), the commissioner may disapprove the provider contract after notice and hearing as provided in 2 Pa.C.S. Chs. 5 Subch. A (relating to practice and procedure of Commonwealth agencies) and 7 Subch. A (relating to judicial review of Commonwealth agency action).(e) Department of Health authority.-- Nothing in this section shall be construed to expand or limit the authority of the Department of Health to review provider contracts under its authority under the act of December 29, 1972 (P.L. 1701, No. 364), known as the Health Maintenance Organization Act, and section 630 of the act of May 17, 1921 (P.L. 682, No. 284), known as The Insurance Company Law of 1921, and regulations promulgated thereunder, including review of size of network and quality of care provided.1996, Dec. 18, P.L. 1066, No. 159, § 509, added 2011, Dec. 22, P.L. 615, No. 134, § 7.