H0347B0369A01943 MSP:JSL 06/08/15 #90 A01943
AMENDMENTS TO HOUSE BILL NO. 347
Sponsor: REPRESENTATIVE BARRAR
Printer's No. 369
Amend Bill, page 3, line 3, by striking out "emergency
medical services" and inserting
EMS
Amend Bill, page 3, line 4, by striking out "properly"
Amend Bill, page 3, line 7, by inserting after "under "
and in accordance with
Amend Bill, page 3, line 8, by striking out "emergency
medical services" and inserting
EMS
Amend Bill, page 3, lines 9 and 10, by striking out
"emergency medical services " and inserting
EMS
Amend Bill, page 3, lines 11 through 13, by striking out all
of said lines and inserting
(b) Reimbursement.--An insurer must reimburse a nonnetwork
EMS agency under the following conditions:
(1) The EMS agency has submitted a completed
standardized form to the department requesting nonnetwork
direct reimbursement from an insurer an EMS agency has
identified. The form must be submitted to the department
annually by October 15. The form shall declare the EMS
agency's intention to receive direct payment from an insurer
identified on the form for the next calendar year. The
department shall develop a standardized form, using an EMS
agency's assigned license number, to be used by an EMS agency
that meets the conditions established under this section.
The department shall develop and maintain a publicly
accessible registry that indicates which EMS agency has
requested nonnetwork direct reimbursement from an insurer
identified on the form.
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(2) An EMS agency has provided notification to the
insurer upon submitting a claim for reimbursement that the
EMS agency is registered with the department to receive
direct reimbursement as provided for under this section.
(c) Periodic audit.--An EMS agency may be subject to
periodic audits by an insurer to examine claims for direct
reimbursement under this chapter. If, through the audit, the
payer identifies an improper payment, the payer may deduct the
improper payment from future reimbursements. The insurer must
forward the insurer's findings to the department.
(d) Insured.--An EMS agency paid by an insurer under this
section may not bill the insured directly or indirectly or
otherwise attempt to collect from the insured for the service
provided, except for a billing to recover a copayment,
coinsurance or deductible as specified in the health insurance
policy.
(e) Donations, etc.--
(1) An EMS agency that submits a form under this section
may solicit donations, memberships or conduct fundraising,
except that an EMS agency may not promise, suggest or infer
to donors that a donation will result in the donor not being
billed directly for any payment as provided under this
section. Notwithstanding this paragraph, an EMS agency may
bill in accordance with subsection (d).
(2) Material used for soliciting for donations or
memberships must state substantially that a donation or
membership may potentially limit out-of-pocket expenses. A
violation of this section shall be considered a violation of
the act of December 17, 1968 (P.L.1224, No.387), known as the
Unfair Trade Practices and Consumer Protection Law.
(f) Clean claim.--An insurer must remit payment of a clean
claim directly to the EMS agency in accordance with section 2166
of the act of May 17, 1921 (P.L.682, No.284), known as The
Insurance Company Law of 1921 . A payment to an insured shall not
constitute compliance with this section.
(g) Application.--This section shall apply only to an EMS
agency that is a nonnetwork provider and provides 911 emergency
care.
Amend Bill, page 3, line 14, by striking out "in 60 days" and
inserting
January 1, 2016
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