Pennsylvania Statutes Title 40 P.S. Insurance § 991.2181. Departmental powers and duties

(a) Records and documents submitted to an insurer or MA or CHIP managed care plan or utilization review entity as part of any complaint, grievance, internal appeals or adverse benefit determination shall be made available to the department, upon request, notwithstanding section 2181.1,  1 and may be used for purposes of enforcement or compliance with this article.

(b) The department shall compile aggregate data received from an insurer or MA or CHIP managed care plan on an annual basis regarding the number, type and disposition of complaints, grievances, internal appeals and adverse benefits determinations filed with an insurer or MA or CHIP managed care plan under this article.

(c) The department shall issue guidelines identifying those provisions of this article that exceed or are not included in the “Standards for the Accreditation of Managed Care Organizations” published by the National Committee for Quality Assurance. These guidelines shall be published in the Pennsylvania Bulletin and updated as necessary. Copies of the guidelines shall be made available to insurers, MA or CHIP managed care plans, health care providers and covered persons and enrollees upon request.

(d) The department shall ensure compliance with this article. The department may investigate potential violations of the article based upon information received from covered persons, enrollees, health care providers and other sources.

(e) Deleted by 2022, Nov. 3, P.L. 2068, No. 146, § 8, effective Jan. 1, 2024.

(f) The department shall submit an annual report to the chairperson and minority chairperson of the Banking and Insurance Committee of the Senate and the chairperson and minority chairperson of the Insurance Committee of the House of Representatives regarding the implementation, operation and enforcement of this article, including the aggregate data the department has compiled under subsection (b).