Regular Session 2023-2024 Senate Bill 0544 P.N. 0530

PRINTER'S NO. 530

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

544

Session of

2023

INTRODUCED BY CAPPELLETTI, HAYWOOD, KANE, FONTANA, PENNYCUICK,

COMITTA, SCHWANK, COSTA, SANTARSIERO AND STREET,

MARCH 28, 2023

REFERRED TO BANKING AND INSURANCE, MARCH 28, 2023

AN ACT

Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

act relating to insurance; amending, revising, and

consolidating the law providing for the incorporation of

insurance companies, and the regulation, supervision, and

protection of home and foreign insurance companies, Lloyds

associations, reciprocal and inter-insurance exchanges, and

fire insurance rating bureaus, and the regulation and

supervision of insurance carried by such companies,

associations, and exchanges, including insurance carried by

the State Workmen's Insurance Fund; providing penalties; and

repealing existing laws," in casualty insurance, providing

for coverage for anti-obesity treatments; and abrogating a

regulation.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921, is amended by adding a

section to read:

Section 635.9. Coverage for Anti-Obesity Treatments.--(a)

Notwithstanding any other provision of law, all of the following

shall be considered compensable items or services under the

Commonwealth's medical assistance program:

(1) Bariatric surgery and related treatments for obesity and

morbid obesity when the prescribing physician has issued a

written order stating that treatment is in accordance with the

patient qualifications and treatment standards provided by the

American Society for Metabolic and Bariatric Surgery or the

American College of Surgeons, subject to the following:

(i) Related treatment may include, but not be limited to,

preoperative psychological screening and counseling, behavior

modification, weight loss, exercise regimens, nutritional

counseling and postoperative follow-up, overview and counseling

of dietary, exercise and lifestyle changes.

(ii) The insured shall be at least eighteen (18) years of

age.

(2) An anti-obesity drug when it is included:

(i) in the definition of "covered outpatient drug" under 42

U.S.C. § 1396r-8(k) (relating to payment for covered outpatient

drugs) and subject to 42 U.S.C. § 1396r-8(a)(1); and

(ii) on the Pennsylvania Medical Assistance Statewide

Preferred Drug List authorized under section 459.1 of the act of

June 13, 1967 (P.L.31, No.21), known as the "Human Services

Code."

(b) Notwithstanding any other provision of law, a health

insurer that issues or renews a health insurance policy

providing benefits for medical or hospital expenses to insureds

residing in this Commonwealth shall provide to the insured under

the health insurance policy coverage for all of the following:

(1) Bariatric surgery and related treatments for obesity and

morbid obesity when the prescribing physician has issued a

written order stating that treatment is in accordance with the

patient qualifications and treatment standards provided by the

American Society for Metabolic and Bariatric Surgery or the

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American College of Surgeons, subject to the following:

(i) Related treatment may include, but not be limited to,

preoperative psychological screening and counseling, behavior

modification, weight loss, exercise regimens, nutritional

counseling and postoperative follow-up, overview and counseling

of dietary, exercise and lifestyle changes.

(ii) The insured shall be at least eighteen (18) years of

age.

(iii) An entity subject to this subsection shall provide the

benefits required under this subsection to the same extent as

for other medically necessary surgical procedures and treatments

under the insured's contract or policy with the entity.

(2) An anti-obesity drug approved by the Food and Drug

Administration of the United States Department of Health and

Human Services.

(1) "Health insurance policy" means the following:

(i) A group or individual health or sickness or accident

insurance policy, subscriber contract or certificate issued by

an entity subject to any one of the following:

(A) Section 630 and Article XXIV of this act.

(B) The act of December 29, 1972 (P.L.1701, No.364), known

as the "Health Maintenance Organization Act."

corporations) or 63 (relating to professional health services

plan corporations).

(ii) The term does not include accident only, fixed

indemnity, hospitality indemnity, limited benefit, credit,

dental, vision, specified disease, Medicare supplement, Civilian

Health and Medical Program of the Uniformed Services (CHAMPUS)

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supplement, long-term care or disability income, workers'

compensation or automobile medical payment insurance.

(2) "Health insurer" means an entity licensed by the

Pennsylvania Insurance Department with accident and health

authority to issue a policy, subscriber contract, certificate or

plan that provides medical or health care coverage that is

offered or governed under any of the following:

(i) This act.

(ii) The "Health Maintenance Organization Act."

(iii) 40 Pa.C.S. Ch. 61 or 63.

(3) "Insured" means a person on whose behalf an insurer is

obligated to pay covered health care expense benefits or provide

health care services under a health insurance policy. The term

includes:

(i) A policyholder, subscriber, certificate holder, member,

dependent or other individual who is eligible to receive health

care services through a health insurance policy.

(ii) All individuals named in a health insurance policy

issued by a health insurer.

Section 2. The addition of section 635.9 of the act shall

apply to health insurance policies offered, issued or renewed on

or after the effective date of this section.

Section 3. The provisions of 55 Pa. Code § 1121.54(1) are

abrogated insofar as they are inconsistent with the addition of

section 635.9(a)(2) of the act.

Section 4. This act shall take effect in 60 days.

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