PA Compensation Fund (MCARE)
- March 25, 2019
- Posted by: Robert Gleyzer
- Category: Home Healthcare
With advances in technology and changes in healthcare, Pennsylvania Mcare (Medical Care Availability and Reduction of Error Fund) will become history. Mcare’s establishment in 2002 was to succeed the Medical Professional Liability Catastrophe Loss Fund (CAT Fund). The purpose of PA Mcare is to ensure that individuals that are hurt due to medical malpractice receive reasonable compensation. The definition for eligibility for Pennsylvania Mcare is in the NPDB (National Practitioner Data Bank) guidebook.
Pennsylvania state law requires a re-evaluation of Mcare every two years. Once private insurance can handle medical malpractice 100%, the phase out of the Mcare PCF, (Patient Compensation Fund) will begin. PA Mcare is a positive answer for individuals hurt due to medical negligence, but the State Fund currently has a $2 billion-dollar deficit.
In the present healthcare system, primary insurers (private markets) cover a maximum of $500,000. State-run Pennsylvania Mcare covers claims over $500,000 due to malpractice. The Pennsylvania State Fund Mcare cap is $500,000. Minimum medical malpractice PA limits for doctors and surgeons is $1,000,000. The JUA (Pennsylvania Professional Liability Joint Underwriting Association) receives the premiums for Mcare. In time, private insurers will be able to increase the primary limits of insurance and absorb the $500,000 of Mcare, phasing it out.
Health care professionals conducting less than 50% of their practice in Pennsylvania in an annual period are exempt from Mcare. Nonparticipating professionals need primary insurance coverage limits of $1 million per claim and $3 million per annual aggregate.
According to the medical malpractice PA law, the statute of limitations for claims is two years after (1) the date the patient knows injury has occurred, (2) the reason for the injury, and (3) the connection between the injury and the treatment. A medical malpractice claim must occur within seven years from the date of injury unless a foreign object is left in the body.
Mcare focuses on claims, compliance, and coverage making it a mediator in the claims process, and providing a neutral perspective on the dispute. Mcare recognizes that each claim is unique. To proceed in the Mcare process, evidence of insurability and the required insurance is a MUST. If the provider fails to submit necessary information, suspension or revocation of licensing is possible. It is important to remember that Mcare funding is through participating health care providers, not taxpayers.
HAP (Healthcare Association of Pennsylvania) supports Mcare reforms. Legiscan shows that the state legislature has 3 bills currently in committees for review and reform. The improvements under review are on the Mcare commission for doctors, emergency care, and punitive damages. Mcare is not the end all be all. It is a work in progress and a helpmeet for Pennsylvania citizens and medical providers.