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PRINTER'S NO. 4162
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2711
Session of
2020
INTRODUCED BY WARREN, JULY 30, 2020
REFERRED TO COMMITTEE ON INSURANCE, JULY 30, 2020
AN ACT
Providing for an extension of preauthorization for health care
service during disaster emergencies and for enforcement by
the Insurance Department.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Disaster
Emergency Health Insurance Preauthorization Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Health care provider." A hospital, health care facility or
person that is licensed, certified or otherwise authorized by
the laws of this Commonwealth to provide health care in the
ordinary course of business or practice of a profession.
"Health care service." A covered elective and nonurgent
admission or procedure provided, or proposed to be provided, by
a health care provider to an individual covered under a health
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insurance policy. The term does not include a pharmaceutical
benefit.
"Health insurance policy." An individual or group health
insurance policy, contract or plan that provides coverage for
services provided by a health care facility or health care
provider that is offered by a health insurer. The term does not
include:
(1) Accident only.
(2) Fixed indemnity.
(3) Limited benefit.
(4) Credit only.
(5) Specified disease.
(6) Medicare supplement.
(7) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(8) Long-term care or disability income.
(9) Workers' compensation.
(10) Automobile medical payment insurance.
"Health insurer." An entity that holds a valid license by
the Insurance Department with accident and health authority to
issue a health insurance policy and 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.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Chs. 61 (relating to hospital plan
corporations) and 63 (relating to professional health
services plan corporations).
"Preauthorization." A review by a health insurer, or an
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entity acting on behalf of a health insurer, of all reasonably
necessary supporting information and documentation that occurs
prior to the delivery of a health care service and results in a
decision to approve or deny payment for the health care service.
Section 3. Extension of preauthorization during disaster
emergencies.
A preauthorization for a health care service both approved
prior to and in effect on the date of a declaration by the
Governor of disaster emergency under 35 Pa.C.S. § 7301(c)
(relating to general authority of Governor) shall remain
approved during the disaster emergency and for not less than 90
days from the date the disaster emergency terminates or expires
under 35 Pa.C.S. § 7301(c), subject to the terms and conditions
of a health insurance policy.
Section 4. Enforcement.
(a) Duty of department.--The Insurance Department shall
enforce the provisions of this act.
(b) Violation.--A violation of this act shall be deemed a
violation of Article VI of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921.
Section 5. Applicability.
This act shall apply only to a health insurance policy in
effect during:
(1) The proclamation of disaster emergency issued by the
Governor on March 6, 2020, published at 50 Pa.B. 1644 (March
21, 2020), and any renewal of the state of disaster
emergency.
(2) Any other declaration of disaster emergency issued
by the Governor due to virus, bacterium or other
microorganism under 35 Pa.C.S. § 7301(c) (relating to general
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authority of Governor) after the effective date of this
section.
Section 6. Effective date.
This act shall take effect immediately.
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