PRINTER'S NO. 2347
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1867
Session of
2023
INTRODUCED BY VENKAT, SANCHEZ, KAZEEM, MADDEN, McANDREW, KHAN,
MAYES, WEBSTER, BOROWSKI, HADDOCK, BURGOS AND KENYATTA,
NOVEMBER 30, 2023
REFERRED TO COMMITTEE ON INSURANCE, NOVEMBER 30, 2023
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for payment choice; and imposing
penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 47
PAYMENT CHOICE
Sec.
4701. Definitions.
4702. Payment.
4703. Regulations.
4704. Enforcement.
§ 4701. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
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context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive health care services under
a health insurance policy.
"Credit card payment." A type of electronic funds transfer
in which a health insurer or its contracted vendor issues a
single-use series of numbers associated with the payment of
covered health care services performed by a participating health
care provider and chargeable at a predetermined rate for which
the health care provider is responsible for processing the
payment by a credit card terminal or Internet portal. The term
includes virtual or online credit card payments for which no
physical card is presented to the health care provider and the
single-use credit card expires upon payment processing.
"Electronic funds transfer." A payment of any method of
electronic funds transfer other than through the Automated
Clearing House Network, as codified in 45 CFR 162.1601 (relating
to health care electronic funds transfers (EFT) and remittance
advice transaction) and 162.1602 (relating to standards for
health care electronic funds transfers (EFT) and remittance
advice transaction).
"Health care billing agent." A person who establishes a
contractual arrangement with a participating health care
provider to process bills for services provided by the health
care provider under terms and conditions established between the
agent and the health care provider. The contracts may permit the
health care billing agent to submit bills, request
reconsideration and receive reimbursements.
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"Health care provider." A licensed hospital or health care
facility, medical equipment supplier or person who is licensed,
certified or otherwise regulated to provide health care services
under the laws of this Commonwealth, including a physician,
podiatrist, optometrist, psychologist, physical therapist,
certified nurse practitioner, registered nurse, nurse midwife,
physician's assistant, chiropractor, dentist, pharmacist or an
individual accredited or certified to provide behavioral health
services. The term includes an individual providing emergency
services under a licensed emergency medical services agency as
defined in 35 Pa.C.S. § 8103 (relating to definitions).
"Health care service." A covered treatment, admission,
procedure, medical supplies and equipment or other service,
including behavioral health, prescribed or otherwise provided or
proposed to be provided by a health care provider to a covered
person for the diagnosis, prevention, treatment, cure or relief
of a health condition, illness, injury or disease under the
terms of health insurance policy.
"Health insurance policy." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term does not include any of the
following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
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(7) A fixed indemnity policy.
(8) A hospital indemnity policy.
(9) A workers' compensation policy.
(10) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(11) A homeowner's insurance policy.
(12) Any other similar policies providing for limited
benefits.
"Health insurer." An entity that offers, issues or renews a
health insurance policy that is offered or governed under any of
the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) Chapter 61 (relating to hospital plan corporations).
(4) Chapter 63 (relating to professional health services
plan corporations).
"Participating health care provider." A health care provider
that has entered into a contractual or operating relationship
with a health insurer to participate in one or more designated
networks of the health insurer and to provide health care
services to covered persons under the terms of the health
insurer's administrative policy.
§ 4702. Payment.
(a) Payment.--A health insurer or its contracted vendor may
not restrict the method of payment to a participating health
care provider so that the exclusive payment method is a credit
card payment.
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(b) Changing payment.--If initiating or changing payments to
a participating health care provider using electronic funds
transfer payments, including credit card payments, a health
insurer or its contracted vendor shall:
(1) Advise the health care provider of all available
payment methods.
(2) Notify the health care provider of any fees imposed
by the health insurer or through its contracted vendor. A
contracted vendor may not include a financial institution
chosen by the health care provider.
(3) Provide clear instructions to the health care
provider for the process of selecting a payment method.
(4) Not charge a fee solely to transmit the payment to
the health care provider, unless the health care provider has
consented to the fee.
(c) Fees.--
(1) A health insurer or its contracted vendor that
initiates or changes payments to a participating health care
provider through the Automated Clearing House Network, as
defined in 45 CFR 162.1601 (relating to health care
electronic funds transfers (EFT) and remittance advice
transaction) and 162.1602 (relating to standards for health
care electronic funds transfers (EFT) and remittance advice
transaction), may not charge a fee solely to transmit the
payment to the health care provider unless the health care
provider has consented to the fee.
(2) A health care billing agent may charge reasonable
fees to a health care provider for Automated Clearing House
Network payments related to transaction management, data
management, portal services and other value-added services in
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addition to the bank transmittal.
(d) Waiver prohibited.--The provisions of this section may
not be waived by contract, and any contractual clause in
conflict with the provisions of this section or that purport to
waive any requirements of this section are void.
§ 4703. Regulations.
The department may promulgate rules and regulations necessary
to implement this chapter.
§ 4704. Enforcement.
(a) Penalties.--Upon satisfactory evidence of the violation
of this chapter by a health insurer or any other person, one or
more of the following penalties may be imposed at the
commissioner's discretion:
(1) A fine of not more than $5,000 for each violation of
this chapter.
(2) A fine of not more than $10,000 for each willful
violation of this chapter.
(b) Limitations.--
(1) Fines imposed against an individual insurer under
this chapter may not exceed $500,000 in the aggregate during
a single calendar year.
(2) Fines imposed against any other person under this
chapter may not exceed $100,000 in the aggregate during a
single calendar year.
(c) Additional remedies.--The enforcement remedies imposed
under this section are in addition to any other remedies or
penalties that may be imposed under any other applicable law of
this Commonwealth, including:
(1) The act of July 22, 1974 (P.L.589, No.205), known as
the Unfair Insurance Practices Act. Violations of this
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chapter shall be deemed to be an unfair method of competition
and an unfair or deceptive act or practice under that act.
(2) The act of December 18, 1996 (P.L.1066, No.159),
known as the Accident and Health Filing Reform Act.
(3) The act of June 25, 1997 (P.L.295, No.29), known as
the Pennsylvania Health Care Insurance Portability Act.
(d) Administrative procedure.--The administrative provisions
of this section shall be subject to 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies). A
party against whom penalties are assessed in an administrative
action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
Ch. 7 Subch. A (relating to judicial review of Commonwealth
agency action).
Section 2. This act shall apply to contracts offered,
entered, issued or renewed after the effective date of this
section.
Section 3. This act shall take effect in 60 days.
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