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PRIOR PRINTER'S NO. 1172
PRINTER'S NO. 1709
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1013
Session of
2017
INTRODUCED BY BARRAR, BOBACK, R. BROWN, CHARLTON, D. COSTA, COX,
DAVIS, FARRY, GABLER, GILLEN, MASSER, O'NEILL, ORTITAY,
READSHAW, ROZZI, SACCONE, SNYDER, WARD, CAUSER, RADER,
GODSHALL, DUSH AND BARBIN, MARCH 28, 2017
AS REPORTED FROM COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
PREPAREDNESS, HOUSE OF REPRESENTATIVES, AS AMENDED,
MAY 10, 2017
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 QUALITY HEALTH CARE
ACCOUNTABILITY AND PROTECTION, further providing FOR
DEFINITIONS AND for emergency services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2116 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921, is amended
to read:
SECTION 1. THE DEFINITION OF "EMERGENCY SERVICE" IN SECTION
2102 OF THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS THE
INSURANCE COMPANY LAW OF 1921, IS AMENDED TO READ:
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SECTION 2102. DEFINITIONS.--AS USED IN THIS ARTICLE, THE
FOLLOWING WORDS AND PHRASES SHALL HAVE THE MEANINGS GIVEN TO
THEM IN THIS SECTION:
* * *
"EMERGENCY SERVICE." ANY HEALTH CARE SERVICE PROVIDED TO AN
ENROLLEE AFTER THE SUDDEN ONSET OF A MEDICAL CONDITION THAT
MANIFESTS ITSELF BY ACUTE SYMPTOMS OF SUFFICIENT SEVERITY OR
SEVERE PAIN SUCH THAT A PRUDENT LAYPERSON WHO POSSESSES AN
AVERAGE KNOWLEDGE OF HEALTH AND MEDICINE COULD REASONABLY EXPECT
THE ABSENCE OF IMMEDIATE MEDICAL ATTENTION TO RESULT IN:
(1) PLACING THE HEALTH OF THE ENROLLEE OR, WITH RESPECT TO A
PREGNANT WOMAN, THE HEALTH OF THE WOMAN OR HER UNBORN CHILD IN
SERIOUS JEOPARDY;
(2) SERIOUS IMPAIRMENT TO BODILY FUNCTIONS; OR
(3) SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART.
[EMERGENCY TRANSPORTATION AND RELATED EMERGENCY SERVICE PROVIDED
BY A LICENSED AMBULANCE SERVICE SHALL CONSTITUTE AN EMERGENCY
SERVICE.] A HEALTH CARE SERVICE PROVIDED BY A LICENSED AMBULANCE
SERVICE, WITH OR WITHOUT EMERGENCY TRANSPORTATION, SHALL
CONSTITUTE AN EMERGENCY SERVICE.
* * *
SECTION 2. SECTION 2116 OF THE ACT IS AMENDED TO READ:
Section 2116. Emergency Services.--(a) If an enrollee seeks
emergency services and the emergency health care provider
determines that emergency services are necessary, the emergency
health care provider shall initiate necessary intervention to
evaluate and, if necessary, stabilize the condition of the
enrollee without seeking or receiving authorization from the
managed care plan. The managed care plan shall pay all
reasonably necessary costs associated with the emergency
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services provided during the period of the emergency. When
processing a reimbursement claim for emergency services, a
managed care plan shall consider both the presenting symptoms
and the services provided. The emergency health care provider
shall notify the enrollee's managed care plan of the provision
of emergency services and the condition of the enrollee. If an
enrollee's condition has stabilized and the enrollee can be
transported without suffering detrimental consequences or
aggravating the enrollee's condition, the enrollee may be
relocated to another facility to receive continued care and
treatment as necessary.
(b) If an emergency medical services agency is dispatched by
a public safety answering point, as defined in 35 Pa.C.S. ยง 5302
(relating to definitions) and provides medically necessary
emergency care SERVICES , including advanced life support
services under 35 Pa.C.S. Ch. 81 (relating to emergency medical
services system), to an enrollee and the enrollee does not
require transport or refuses to be transported, the managed care
plan shall pay all reasonably necessary costs associated with
the emergency services provided during the period of the
emergency. THE MANAGED CARE PLAN MAY NOT MAKE A DETERMINATION
THAT EMERGENCY SERVICES WERE NOT MEDICALLY NECESSARY SOLELY ON
THE BASIS THAT THE ENROLLEE DID NOT REQUIRE TRANSPORT OR REFUSED
TO BE TRANSPORTED.
Section 2 3. This act shall take effect in 60 days.
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