PRINTER'S NO. 2357
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1113
Session of
2015
INTRODUCED BY BIZZARRO, YOUNGBLOOD, DRISCOLL, KINSEY, CUTLER,
ROZZI, THOMAS, MURT, McNEILL, WATSON, CAUSER, BARRAR, PAYNE,
PASHINSKI, MAHONEY AND COHEN, OCTOBER 15, 2015
REFERRED TO COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
PREPAREDNESS, OCTOBER 15, 2015
AN ACT
Providing for certification of community paramedics, for
community paramedicine service coverage by casualty insurance
carriers and for medical assistance reimbursement.
TABLE OF CONTENTS
Chapter 1. Preliminary Provisions
Section 101. Short title.
Section 102. Definitions.
Chapter 3. Community Paramedicine Services
Section 301. Certification.
Section 302. Status.
Section 303. Regulations.
Chapter 5. Financial Provisions
Section 501. Casualty insurance coverage.
Section 502. Medical assistance reimbursement.
Chapter 7. Miscellaneous Provisions
Section 701. (Reserved).
Section 702. Effective date.
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The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
CHAPTER 1
PRELIMINARY PROVISIONS
Section 101. Short title.
This act shall be known and may be cited as the Community
Paramedicine Services Act.
Section 102. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Community paramedicine services." Any of the following
services provided by a community paramedicine provider:
(1) Coordination of community services.
(2) Chronic disease monitoring and education.
(3) Health assessments.
(4) Hospital discharge follow-up care.
(5) Medication compliance.
(6) Minor medical procedures approved by an emergency
medical services agency medical director.
(7) Such other services as approved by regulation of the
department.
"Community paramedicine provider." An individual who is an
EMS provider and performs community paramedicine services.
"Department." The Department of Health of the Commonwealth.
"EMS provider." As defined in 35 Pa.C.S. § 8103 (relating to
definitions).
"Health insurance policy." An individual or group health
insurance policy, subscriber contract, certificate or plan that
provides medical or health care coverage by any health care
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facility or licensed health care provider that is offered by or
is governed under the act of May 17, 1921 (P.L.682, No.284),
known as The Insurance Company Law of 1921, or any of the
following:
(1) Subarticle (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the Public Welfare Code.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) A nonprofit corporation subject to 40 Pa.C.S. Chs.
61 (relating to hospital plan corporations) and 63 (relating
to professional health services plan corporations).
The term includes a Medicare supplement policy.
"Secretary." The Secretary of Health of the Commonwealth.
CHAPTER 3
COMMUNITY PARAMEDICINE SERVICES
Section 301. Certification.
An individual who is certified for any of the types of EMS
providers enumerated under 35 Pa.C.S. § 8113(a) (relating to
emergency medical services providers) shall be entitled to
provide community paramedicine services, subject to disciplinary
action pursuant to 35 Pa.C.S. § 8121 (relating to certification
sanctions).
Section 302. Status.
A community paramedicine provider shall be deemed an
emergency medical services provider or EMS provider for purposes
of 35 Pa.C.S. Ch. 81 (relating to emergency medical services
system).
Section 303. Regulations.
Within one year of the effective date of this section, the
department shall promulgate regulations to carry out the
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provisions of this chapter. The regulations shall establish
certification, practice, disciplinary and other standards
consistent with the purposes of this chapter and with the
requirements applicable to EMS providers, except as necessary to
meet the need for community paramedicine providers.
CHAPTER 5
FINANCIAL PROVISIONS
Section 501. Casualty insurance coverage.
(a) General rule.--A health insurance policy delivered,
issued, executed or renewed in this Commonwealth on or after the
effective date of this section shall provide coverage for
community paramedicine services.
(b) Copayments, coinsurance and deductible amounts.--
Coverage under this section shall remain subject to any
copayment, coinsurance or deductible amounts set forth in the
policy.
(c) Prerequisites for coverage.--To qualify for coverage
under this section, community paramedicine services must be:
(1) Ordered by an emergency medical services agency
medical director.
(2) Part of a patient care plan that has been developed
by the patient's health care practitioner, in conjunction
with the emergency medical services agency medical director.
(d) Duty of Department of Human Services.--The Department of
Human Services shall seek such waivers or Federal approvals as
may be necessary to ensure that actions taken pursuant to this
section comply with applicable Federal law.
(e) Nonapplicability.--This section shall not apply to the
following types of policies:
(1) Accident only.
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(2) Limited benefit.
(3) Credit.
(4) Dental.
(5) Vision.
(6) Specified disease.
(7) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(8) Long-term care or disability income.
(9) Workers' compensation.
(10) Automobile medical payment.
Section 502. Medical assistance reimbursement.
(a) Duty of Secretary of Human Services.--The Secretary of
Human Services shall, in consultation with the Department of
Health and representatives of emergency medical services
providers, physicians, public health nurses and local public
health agencies, determine specified services and payment rates
for community paramedicine services to be performed by community
paramedicine providers under this act, to be covered by medical
assistance under the laws of this Commonwealth.
(b) Payment.--
(1) Payment for community paramedicine services must be
billed by an eligible medical assistance enrolled provider
that employs or contracts with the community paramedicine
provider.
(2) In determining the community paramedicine services
to include under medical assistance coverage, the Secretary
of Human Services shall consider the potential of hospital
admittance, emergency room utilization deductions and
increased access to quality care.
CHAPTER 7
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MISCELLANEOUS PROVISIONS
Section 701. (Reserved).
Section 702. Effective date.
This act shall take effect in 60 days.
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