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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 3392 (June 24, 2023).

31 Pa. Code § 243.5. Approval of risk management plan by Commissioner.

§ 243.5. Approval of risk management plan by Commissioner.

 An insurance company, entity, association or other unit desiring to gain approval of a plan of risk management to which health care providers may subscribe in fulfillment of the requirements under this chapter shall submit the plan to the Commissioner for approval. Before the Commissioner will grant approval, a plan shall have the following:

   (1)  A complete risk management manual containing a detailed description of the operation of the plan.

   (2)  An established broad-based risk management committee. The committee shall at least include the risk manager, the chief executive officer or a designee from administration, the president of the medical staff or a designee who is a member of the medical staff, the director of nursing or a designee who is a registered nurse and a member of the medical records department.

   (3)  A subscription to a hospital utilization project or its equivalent.

   (4)  A risk management monitoring system to include self audits done on a scheduled basis.

   (5)  An operational set of medical staff bylaws approved by the Joint Commission on Accreditation of Hospitals or the Department of Health.


   The provisions of this §  243.5 amended under The Insurance Department Act of 1921 (40 P. S. § §  1—321); The Insurance Company Law of 1921 (40 P. S. § §  341—991); and sections 206, 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S. § §  66, 186, 411 and 412); and the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006).


   The provisions of this §  243.5 adopted July 1, 1977, effective July 2, 1977, 7 Pa.B. 1816; renumbered February 9, 1979, 9 Pa.B. 498; amended September 18, 1987, effective November 18, 1987, 17 Pa.B. 3742. Immediately preceding text appears at serial page (39845).

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