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PRIOR PRINTER'S NO. 1382
PRINTER'S NO. 1389
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1003
Session of
2017
INTRODUCED BY WHITE, DECEMBER 12, 2017
SENATOR WHITE, BANKING AND INSURANCE, AS AMENDED,
DECEMBER 13, 2017
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in quality health care
accountability and protection, further providing for
emergency services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2116 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921, is amended
to read:
Section 2116. Emergency Services.--[If] (a) Except as
provided in subsection (b), if an enrollee seeks emergency
services and the emergency health care provider determines that
emergency services are necessary, the emergency health care
provider shall initiate necessary intervention to evaluate and,
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if necessary, stabilize the condition of the enrollee without
seeking or receiving authorization from the managed care plan.
[The managed care plan shall pay all reasonably necessary costs
associated with the emergency services provided during the
period of the emergency.] The managed care plan shall pay any
reasonably necessary costs associated with medically necessary
emergency services provided during the period of emergency,
subject to any copayment, coinsurance or deductible as specified
in the health insurance policy and consistent with the managed
care plan's medical policies. When processing a reimbursement
claim for emergency services, a managed care plan shall consider
both the presenting symptoms and the services provided. The
emergency health care provider shall notify the enrollee's
managed care plan of the provision of emergency services and the
condition of the enrollee. If an enrollee's condition has
stabilized and the enrollee can be transported without suffering
detrimental consequences or aggravating the enrollee's
condition, the enrollee may be relocated to another facility to
receive continued care and treatment as necessary.
( b) For emergency services provided to an enrollee by an
emergency medical services agency, the managed care plan shall
pay any reasonably necessary costs associated with medically
necessary emergency services provided during the period of
emergency, subject to any copayment, coinsurance or deductible
as specified in the health insurance policy and consistent with
the managed care plan's medical policies. The managed care plan
shall pay only FOR SERVICES RENDERED BY licensed emergency
medical services agencies that have the ability to transport
patients or are providing and billing for services under an
agreement with an agency which has that ability. The managed
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care plan may not deny a claim for payment of costs solely
because the enrollee did not require transport or refused to be
transported.
(c) The provisions of subsection (b) shall apply to the same
services provided to recipients of medical assistance under
Article IV of the act of June 13, 1967 (P.L.31, No.21), known as
the Human Services Code. Sufficient funds shall be appropriated
each fiscal year for payment of the services.
(D) THE PROVISIONS OF SUBSECTION (B) SHALL APPLY TO ALL
GROUP AND INDIVIDUAL MAJOR MEDICAL HEALTH INSURANCE POLICIES.
Section 2. The amendment of section 2116 of the act shall
apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this section shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this section.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this section shall
apply to any policy issued or renewed on or after 180 days
after the effective date of this section.
Section 3. This act shall take effect in 60 days.
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