THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY ORIE, WARD, BOSCOLA, EARLL, WAUGH AND M. WHITE, FEBRUARY 2, 2012

REFERRED TO BANKING AND INSURANCE, FEBRUARY 2, 2012  

AN ACT

Amending Title 40 (Insurance) of the Pennsylvania Consolidated

Statutes, providing for nondiscrimination by payers in health

care benefit plans. 

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Part III of Title 40 of the Pennsylvania

Consolidated Statutes is amended by adding an article to read:

ARTICLE M

MISCELLANEOUS PROVISIONS

Chapter

91.  Nondiscrimination by Payers in Health Care Benefit Plans

CHAPTER 91

NONDISCRIMINATION BY PAYERS

IN HEALTH CARE BENEFIT PLANS

Sec.

9101.  Definitions.

9102.  Discrimination against willing providers prohibited.

9103.  Construction and application of chapter.

§ 9101.  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:

"Health care benefit plan."  An insurance policy, contract or

plan that provides health care to participants or beneficiaries

directly or through insurance, reimbursement or otherwise.

"Health care payer."  An individual or entity that is

responsible for providing or paying for all or part of the cost

of health care services covered by a health care benefit plan.

The term includes, but is not limited to, an entity subject to:

(1)  Chapter 61 (relating to hospital plan corporations)

or 63 (relating to professional health services plan

corporations);

(2)  the act of May 17, 1921 (P.L.682, No.284), known as

The Insurance Company Law of 1921, including:

(i)  a preferred provider organization subject to

section 630 of The Insurance Company Law of 1921; or

(ii)  a fraternal benefit society subject to Article

XXIV of The Insurance Company Law of 1921;

(3)  the act of December 29, 1972 (P.L.1701, No.364),

known as the Health Maintenance Organization Act;

(4)  an agreement by a self-insured employer or self-

insured multiple employer trust to provide health care

benefits to employees and their dependents.

§ 9102.  Discrimination against willing providers prohibited.

A health care payer shall be required to contract with and to

accept as a health care benefit plan participant any willing

provider of health care services. A health care payer shall not

discriminate against a provider of health care services who:

(1)  agrees to accept the health care payer's standard

payment levels; and

(2)  meets and agrees to adhere to quality standards

established by the health care payer.

§ 9103.  Construction and application of chapter.

(a)  Construction.--This chapter shall not be construed to

prohibit a health care payer from negotiating and paying rates

higher than the health care payer's standard payment levels to

one or more providers.

(b)  Application.--This chapter shall:

(1)  apply to all health care benefit plans that

compensate providers on a fee-for-service basis, per diem or

other nonrisk basis; and

(2)  not apply to health care benefit plans regarding

products that compensate providers on a capitated basis or

under which providers accept significant financial risk in a

formal arrangement approved by Federal or State authorities.

Section 2.  The provisions of this act are severable. If any

provision of this act or its application to any person or

circumstance is held invalid, the invalidity shall not affect

other provisions or applications of this act which can be given

effect without the invalid provision or application.

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