PRINTER'S NO. 334
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
345
Session of
2017
INTRODUCED BY DeLUCA, O'BRIEN, READSHAW, ROZZI, D. MILLER, MURT,
GODSHALL, D. COSTA, MILLARD, THOMAS, FREEMAN, FRANKEL AND
BIZZARRO, FEBRUARY 3, 2017
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 3, 2017
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in special provisions relating to particular
classes of insurers, 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 C
MISCELLANEOUS PROVISIONS
Chapter
69. Nondiscrimination by Payers in Health Care Benefit Plans
CHAPTER 69
NONDISCRIMINATION BY PAYERS
IN HEALTH CARE BENEFIT PLANS
Sec.
6901. Definitions.
6902. Discrimination against willing providers prohibited.
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6903. Construction and application of chapter.
§ 6901. 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.
§ 6902. 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 may not
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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.
§ 6903. Construction and application of chapter.
(a) Construction.--This chapter may 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:
(1) shall apply to all health care benefit plans that
compensate providers on a fee-for-service basis, per diem or
other nonrisk basis; and
(2) may not be applied 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 may not affect
other provisions or applications of this act that can be given
effect without the invalid provision or application.
Section 3. This act shall take effect in 60 days.
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