THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY O'NEILL, DiGIROLAMO, SANTARSIERO, BARRAR, BOYD, BRIGGS, V. BROWN, CALTAGIRONE, CAUSER, CLYMER, P. COSTA, COX, CUTLER, DAVIS, DENLINGER, EVERETT, FABRIZIO, GEIST, GILLESPIE, GINGRICH, GOODMAN, HESS, HORNAMAN, HUTCHINSON, M. K. KELLER, KULA, LONGIETTI, MAHONEY, MARSHALL, MASSER, METZGAR, MILLARD, MILLER, MUNDY, MUSTIO, PASHINSKI, QUINN, READSHAW, REICHLEY, ROAE, SCHRODER, SONNEY, SWANGER, TALLMAN, VEREB, VULAKOVICH, WAGNER, WATSON, GRELL, KORTZ, FARRY, MOUL, MURT AND SACCONE, APRIL 13, 2011

AS REPORTED FROM COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY PREPAREDNESS, HOUSE OF REPRESENTATIVES, AS AMENDED, JUNE 15, 2011   

AN ACT

Amending Title 35 (Health and Safety) of the Pennsylvania

Consolidated Statutes, providing for emergency service system

billing.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Section 8103 of Title 35 of the Pennsylvania

Consolidated Statutes is amended by adding a definition to read:

§ 8103.  Definitions.

The following words and phrases when used in this chapter

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

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"Insurer."  As follows:

(1)  An entity that is responsible for providing or

paying for all or part of the cost of ambulance services

covered by an insurance policy, contract or plan. The term

includes an entity subject to:

(i)  the act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921;

(ii)  the act of December 29, 1972 (P.L.1701,

No.364), known as the Health Maintenance Organization

Act; or

(iii)  40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health

services plan corporations).

(2)  The term does not include an entity that is

responsible for providing or paying under an insurance

policy, contract or plan which meets any of the following:

(i)  Is a homeowner's insurance policy.

(ii)  Provides any of the following types of

insurance:

(A)  Accident only.

(B)  Fixed indemnity.

(C)  Limited benefit.

(D)  Credit.

(D)  Dental.

(E)  Vision.

(F)  Specified disease.

(G)  Medicare supplement.

(H)  Civilian Health and Medical Program of the

Uniformed Services (CHAMPUS) supplement.

(I)  Long-term care.

(J)  Disability income.

(K)  Workers' compensation.

(L)  Automobile medical payment insurance.

* * *

Section 2.  Title 35 is amended by adding a section to read:

§ 8158.  Billing.

(a)  Volunteer ambulance service.--If volunteer ambulance

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service Emergency medical services agency.--If an emergency

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medical services agency is properly dispatched by a public

safety answering point as defined in section 5302 (relating to

definitions), and provides medically necessary emergency care, a

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payment made by an insurer for a claim covered under a health

insurance policy for a service performed by the volunteer

<--

ambulance service emergency medical services agency during the

<--

call shall be paid directly to the volunteer ambulance service,

<--

regardless of whether the ambulance service is a participating

provider with the insurer. emergency medical services agency

<--

under subsection (b).

(b)  Emergency medical services.--

(1)  An insured may, through the assignment of benefits,

assign to a willing provider of emergency medical services

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the insurer's insured's right to receive reimbursement for

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service performed by an emergency medical services agency.

(2)  An emergency medical services agency must submit a

copy of the assignment under paragraph (1) or provide a

notice of the assignment of benefits on a form and in a

manner prescribed by the department Insurance Department to

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the insurer with a claim for payment for emergency medical

services performed by the emergency medical services agency. 

The Insurance Department shall develop a standardized

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assignment of benefits form that shall be used by emergency

medical services agencies.

(3)  The insurer, upon the notice and claim under

paragraph (2), shall remit payment of the claim directly to

the emergency medical services agency within the time frame

established by section 2166 of the act of May 17, 1921

(P.L.682, No.284), known as The Insurance Company Law of

1921.

(4)  If there is compliance with paragraphs (1) and (2)

but the insurer remits payment of the claim to the insured,

the claim shall not be considered paid. The insurer shall,

notwithstanding the incorrect payment of the claim to the

insured, remain liable for remitting payment of the claim to

the emergency medical services agency pursuant to the

assignment of benefits.

(5)  If an assignment of benefits is offered by an

<--

emergency medical services agency and assigned by the

insured, the emergency medical services may not bill the

balance to the insured.

(6)  An emergency medical services agency may not submit

separately a claim for reimbursement and an assignment of

benefits for reimbursement.

Section 3.  This act shall take effect in 60 days.