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, 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, SACCONE, DELOZIER, BOBACK AND MALONEY, APRIL 13, 2011

AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, OCTOBER 31, 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 emergency

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medical 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.

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(a)  Emergency medical services agency.-If an emergency

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

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

insurance policy for a service performed by the emergency

medical services agency during the call shall be paid directly

to the emergency medical services agency under subsection (b).

(b)  Emergency medical services.--

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

assign to a provider of emergency medical services the  

insured's right to receive reimbursement for 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 Insurance Department to 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 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.

§ 8158.  Billing.

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(a)  General rule.--When an emergency 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 payment made by an insurer

for a claim covered under a health insurance policy for a

service performed by the emergency medical services agency

during the call shall be paid directly to the emergency medical

services agency.

(b)  Application.--This section shall be construed to apply

only to emergency medical services agencies that are nonnetwork

providers.

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