PRINTER'S NO. 1820
No. 1383 Session of 1998
INTRODUCED BY ARMSTRONG, MARCH 23, 1998
REFERRED TO LABOR AND INDUSTRY, MARCH 23, 1998
AN ACT
1 Amending the act of December 29, 1972 (P.L.1701, No.364),
2 entitled "An act providing for the establishment of nonprofit
3 corporations having the purpose of establishing, maintaining
4 and operating a health service plan; providing for
5 supervision and certain regulations by the Insurance
6 Department and the Department of Health; giving the Insurance
7 Commissioner and the Secretary of Health certain powers and
8 duties; exempting the nonprofit corporations from certain
9 taxes and providing penalties," adding definitions; and
10 regulating health maintenance organizations that perform
11 services relating to worker's compensation.
12 The General Assembly of the Commonwealth of Pennsylvania
13 hereby enacts as follows:
14 Section 1. Section 3 of the act of December 29, 1972
15 (P.L.1701, No.364), known as the Health Maintenance Organization
16 Act, is amended by adding definitions to read:
17 Section 3. Definitions.--As used in this act:
18 * * *
19 "Coordinated Care Organization (CCO)" means a coordinated
20 care organization as defined in the act of June 2, 1915
21 (P.L.736, No.338), known as the "Workers' Compensation Act."
22 "Department of Labor and Industry" means the Department of
1 Labor and Industry of the Commonwealth.
2 * * *
3 "Workers' Compensation Act" means the act of June 2, 1915
4 (P.L.736, No.338), known as the "Workers' Compensation Act."
5 "Workers' compensation services" means those health services,
6 including as a minimum, but not limited to, emergency care,
7 inpatient hospital and physician care, ambulatory physician care
8 and outpatient and rehabilitation medical services.
9 Section 2. Sections 4, 8 and 10 of the act are amended by
10 adding subsections to read:
11 Section 4. Services Which Shall be Provided.--* * *
12 (c) Such health maintenance organizations shall not provide
13 either directly or through arrangements with other persons,
14 corporations, institutions, associations or entities, workers'
15 compensation services unless such health maintenance
16 organizations are certified and regulated as coordinated care
17 organizations as provided in the Workers' Compensation Act.
18 Section 8. Contracts with Practitioners, Hospitals,
19 Insurance Companies, Etc.--* * *
20 (c) A corporation subject to this act shall not require, by
21 contract or otherwise, a practitioner of medical, dental and
22 related services to accept reimbursement rates or payment
23 schedules for workers' compensation services as a condition of
24 participation in any of the corporation's other services.
25 Section 10. Supervision.--* * *
26 (g) If a health maintenance organization offers workers'
27 compensation services, such health maintenance organization
28 shall be certified and regulated as a coordinated care
29 organization as provided in the Workers' Compensation Act.
30 Section 3. Section 16 of the act, amended December 19, 1980
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1 (P.L.1300, No.234), is amended to read:
2 Section 16. Exclusions.--[Certificates] Subject to the
3 provisions of section 10(g), certificates of authority shall not
4 be required of:
5 (1) Health maintenance organizations offered by employers
6 for the exclusive enrollment of their own employes, or by unions
7 for the sole use of their members.
8 (2) Any plan, program or service offered by an employer for
9 the prevention of disease among his employes.
10 Section 4. This act shall take effect in 60 days.
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