A03906
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1512
Session of
2023
INTRODUCED BY SAPPEY, HILL-EVANS, HANBIDGE, D. WILLIAMS,
ISAACSON, BURGOS, MADDEN, GUENST, SANCHEZ, CIRESI, KINSEY,
SCHLOSSBERG, VENKAT, GALLOWAY, HOHENSTEIN, SAMUELSON, DEASY,
FREEMAN, CERRATO, KHAN, HOWARD, WARREN, OTTEN, HARRIS,
KINKEAD, STURLA, CONKLIN, FLEMING, TAKAC, PARKER AND GREEN,
JUNE 26, 2023
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, MARCH 25, 2024
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for telemedicine.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 45
TELEMEDICINE
Sec.
4501. Definitions.
4502. Health insurance coverage of telemedicine services.
4503. Legal standard of care.
4504. Regulations.
4505. Applicability.
§ 4501. Definitions.
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CHAPTER 47
TELEMEDICINE
SEC.
4701. DEFINITIONS.
4702. HEALTH INSURANCE COVERAGE OF TELEMEDICINE SERVICES.
4703. STANDARD OF CARE.
4704. REGULATIONS.
§ 4701. 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:
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive a covered health care
service under a health insurance policy.
"Health care provider." Any of the following:
(1) A health care practitioner as defined in section 103
of the act of July 19, 1979 (P.L.130, No.48), known as the
Health Care Facilities Act.
(2) A federally qualified health center as defined in 42
U.S.C. § 1395x(aa)(4) (relating to definitions).
(3) A rural health clinic as defined in 42 U.S.C. §
1395x(aa)(2).
(4) A general, mental, chronic disease or other type of
hospital licensed in this Commonwealth.
"Health care service." A service for the diagnosis,
prevention, treatment, habilitation, rehabilitation, cure or
relief of a health condition, injury, disease or illness.
"Health insurance policy." As follows:
(1) A policy, subscriber contract, certificate or plan
issued by a health insurer that provides medical or health
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care coverage.
(2) The term does not include any of the following:
(i) An accident only policy.
(ii) A credit only policy.
(iii) A long-term care or disability income policy.
(iv) A specified disease policy.
(v) A Medicare supplement policy.
(vi) A fixed indemnity policy.
(vii) A dental only policy.
(viii) A vision only policy.
(ix) A workers' compensation policy.
(x) An automobile medical payment policy.
(xi) A policy under which benefits are provided by
the Federal Government to active or former military
personnel and their dependents.
(xii) A hospital indemnity policy.
(xiii) Any other similar policies providing for
limited benefits.
"Health insurer." An entity that holds a valid license
issued by the department with accident and health authority to
issue a health insurance policy and governed under any of the
following: AN ENTITY THAT OFFERS, ISSUES OR RENEWS AN INDIVIDUAL
OR GROUP HEALTH INSURANCE POLICY THAT IS OFFERED OR 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, including section 630 and
Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) Chapter 61 (relating to hospital plan corporations).
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(4) Chapter 63 (relating to professional health services
plan corporations).
"Participating health care provider." A health care provider
that has entered into a contractual or operating relationship
with a health insurer to participate in one or more designated
networks of the health insurer and to provide covered health
care services to covered persons under the terms of the
contractual or operating agreement between the health insurer
and the health care provider.
"Provider-to-provider consultation." The act by a health
care provider of seeking advice and recommendations from another
health care provider for diagnostic studies, therapeutic
interventions or other services that may benefit a covered
person who is the patient of the initiator of the consultation.
"Telemedicine." As follows:
(1) The delivery of health care services by a health
care provider who is at a different PHYSICAL location FROM
THE COVERED PERSON , through technology which satisfies the
requirements of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191, 110 Stat.
1936), the Health Information Technology for Economic and
Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and
467-496) or other applicable Federal or State law regarding
the privacy and security of electronic transmission of health
information.
(2) The term does not include any of the following:
(i) The provision of health care services solely
through the use of voicemail, facsimile, email or instant
messaging or a combination thereof.
(ii) A provider-to-provider consultation.
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(2) THE TERM DOES NOT INCLUDE THE PROVISION OF HEALTH
CARE SERVICES SOLELY THROUGH THE USE OF VOICEMAIL, FACSIMILE,
EMAIL OR INSTANT MESSAGING OR A COMBINATION THEREOF.
§ 4502 4702 . Health insurance coverage of telemedicine
services.
(a) Requirements.--
(1) The following apply to health insurers:
(i) A health insurer may not refuse to pay or to
reimburse a participating health care provider or a
covered person for a medically necessary AND APPROPRIATE
covered health care service appropriately provided
through telemedicine to a covered person solely because
the health care service was provided through
telemedicine. PERSON.
(ii) The payment or reimbursement under this
paragraph shall be in accordance with the terms and
conditions of the health insurance policy and, if
applicable, the a network participation agreement as
negotiated between the insurer and the participating
health care provider.
(2) A health insurance policy offered, issued,
delivered, executed or renewed in this Commonwealth may not
contain a provision that refuses to pay or to reimburse a
participating health care provider or a covered person for a
medically necessary AND APPROPRIATE covered health care
service appropriately provided through telemedicine to a
covered person solely because the health care service was
provided through telemedicine .
(3) The network participation agreement:
(i) May not prohibit payment or reimbursement solely
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because a MEDICALLY NECESSARY AND APPROPRIATE COVERED
health care service is appropriately provided through
telemedicine.
(ii) May NOT condition payment or reimbursement upon
the use of an exclusive or proprietary telemedicine
technology or vendor.
(b) Construction.--Nothing in this section shall be
construed to require parity between payments or reimbursements
for health care services provided through telemedicine and
payments or reimbursements for health care services provided
through an in-person encounter.
§ 4503. Legal standard 4703. STANDARD of care.
Health care services provided through telemedicine shall meet
the same legal standard of care that would apply if the health
care service were rendered in an in-person setting.
§ 4504 4704 . Regulations.
(a) Promulgation.--The department may promulgate regulations
to implement this chapter.
(b) Construction.--Nothing in this chapter shall be
construed to diminish a Commonwealth entity's existing
regulatory authority regarding health insurance policies or the
practice of health care.
§ 4505. Applicability.
(a) Rates or forms required.--For a health insurance policy
for which either rates or forms are required to be filed with
the Federal Government or the department, this chapter shall
apply to a policy for which a form or rate is first filed on or
after 180 days after the effective date of this subsection.
(b) Rates and forms not required.--For a health insurance
policy for which neither rates nor forms are required to be
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filed with the Federal Government or the department, this
chapter shall apply to a policy issued or renewed on or after
180 days after the effective date of this subsection.
Section 2. This act shall take effect in 60 days.
SECTION 2. THE FOLLOWING SHALL APPLY:
(1) FOR A HEALTH INSURANCE POLICY FOR WHICH EITHER RATES
OR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT
OR THE DEPARTMENT, 40 PA.C.S. CH. 47 SHALL APPLY TO A POLICY
FOR WHICH A FORM OR RATE IS FIRST FILED ON OR AFTER 180 DAYS
AFTER THE EFFECTIVE DATE OF THIS PARAGRAPH.
(2) FOR A HEALTH INSURANCE POLICY FOR WHICH NEITHER
RATES NOR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL
GOVERNMENT OR THE DEPARTMENT, 40 PA.C.S. CH. 47 SHALL APPLY
TO A POLICY ISSUED OR RENEWED ON OR AFTER 180 DAYS AFTER THE
EFFECTIVE DATE OF THIS PARAGRAPH.
SECTION 3. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
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