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PRINTER'S NO. 1259
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1113
Session of
2017
INTRODUCED BY BIZZARRO, CAUSER, McNEILL, BARRAR, READSHAW,
D. COSTA, WATSON, PASHINSKI AND GILLEN, APRIL 4, 2017
REFERRED TO COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
PREPAREDNESS, APRIL 4, 2017
AN ACT
Amending Title 35 (Health and Safety) of the Pennsylvania
Consolidated Statutes, providing for certification of
community paramedics, for community paramedicine service
coverage by casualty insurance carriers and for medical
assistance reimbursement.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 35 of the Pennsylvania Consolidated
Statutes is amended by adding a part to read:
PART II
PUBLIC HEALTH
Chapter
41. Community Paramedicine Services
CHAPTER 41
COMMUNITY PARAMEDICINE SERVICES
Subchapter
A. Preliminary Provisions
B. Community Paramedicine Services
C. Financial Provisions
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SUBCHAPTER A
PRELIMINARY PROVISIONS
Sec.
4101. Definitions.
§ 4101 . 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:
"Community paramedicine provider." An individual who is
certified as an EMS provider with additional training pursuant
to 28 Pa. Code Pt. VII (relating to emergency medical services)
and who has successfully completed an education program for
community paramedicine health care as prescribed by the
department by regulation. A community paramedicine provider
shall also be considered a "community health worker" for
purposes of the Patient Protection and Affordable Care Act
(Public Law 111-148, 124 Stat. 119).
"Community paramedicine services." Services, provided by
certified EMS providers acting within their scope of practice
pursuant to 28 Pa. Code Pt. VII, to provide outreach, injury and
illness prevention and assistance, based on local need, to
patients who do not require emergency medical transportation.
"Department." The Department of Health of the Commonwealth.
"EMS provider." As defined in section 8103 (relating to
definitions).
"Health insurance policy." An individual or group health
insurance policy, subscriber contract, certificate or plan that
provides medical or health care coverage by any health care
facility or licensed health care provider that is offered by or
is governed under the act of May 17, 1921 (P.L.682, No.284),
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known as The Insurance Company Law of 1921, or any of the
following:
(1) Subarticle (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the Human Services Code.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
The term includes a Medicare supplement policy.
SUBCHAPTER B
COMMUNITY PARAMEDICINE SERVICES
Sec.
4111. Certification.
4112. Status.
4113. Regulations.
§ 4111 . Certification.
An individual who is certified for any of the types of EMS
providers enumerated under section 8113(a) (relating to
emergency medical services providers) shall be permitted to
provide community paramedicine services, subject to disciplinary
action pursuant to section 8121 (relating to certification
sanctions).
§ 4112 . Status.
A community paramedicine provider shall be deemed an
emergency medical services provider or EMS provider for purposes
of Chapter 81 (relating to emergency medical services system).
§ 4113 . Regulations.
Within one year of the effective date of this section, the
department shall promulgate regulations to carry out the
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provisions of this chapter. The regulations shall establish
certification, practice, disciplinary and other standards
consistent with the purposes of this chapter and with the
requirements applicable to EMS providers, except as necessary to
meet the need for community paramedicine providers.
SUBCHAPTER C
FINANCIAL PROVISIONS
Sec.
4121. Casualty insurance coverage.
4122. Medical assistance reimbursement.
§ 4121 . Casualty insurance coverage.
(a) General rule.--A health insurance policy delivered,
issued, executed or renewed in this Commonwealth on or after the
effective date of this section shall provide coverage for
community paramedicine services.
(b) Copayments, coinsurance and deductible amounts.--
Coverage under this chapter shall remain subject to any
copayment, coinsurance or deductible amounts set forth in the
policy.
(c) Prerequisites for coverage.--To qualify for coverage
under this chapter, community paramedicine services must be part
of a care plan ordered by an emergency services agency medical
director, primary health care provider or health insurer as
follows:
(1) The care plan should ensure that community
paramedicine services provided by a community paramedic are
coordinated with other community resources where available.
(2) Community paramedic services shall not duplicate
services already provided to the patient.
(3) Community paramedic services shall include the
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following:
(i) Coordination of community services.
(ii) Health assessment.
(iii) Chronic disease monitoring and education.
(iv) Medication compliance.
(v) Hospital discharge follow-up care.
(vi) Minor medical procedures ordered by an
emergency services agency medical director or primary
health care provider.
(vii) Such other services as approved by regulation
of the department.
(d) Duty of Department of Human Services.--The Department of
Human Services shall seek such waivers or Federal approvals as
may be necessary to ensure that actions taken under this section
comply with applicable Federal law.
(e) Nonapplicability.--This section shall not apply to the
following types of policies:
(1) Limited benefit.
(2) Credit.
(3) Dental.
(4) Vision.
(5) Long-term care or disability income.
§ 4122 . Medical assistance reimbursement.
(a) Duty of Secretary of Human Services.--The Secretary of
Human Services shall, in consultation with the department and
representatives of emergency medical services providers,
physicians and local public health agencies, determine specified
services and payment rates for community paramedicine services
to be performed by community paramedicine providers under this
chapter to be covered by medical assistance under the laws of
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this Commonwealth.
(b) Payment.--
(1) Payment for community paramedicine services under
this chapter must be part of a care plan ordered by a primary
health care provider or medical director of an ambulance
service and must be billed by an eligible provider enrolled
in medical assistance that employs or contracts with the
community paramedicine provider.
(2) In determining the community paramedicine services
to include under medical assistance coverage, the Secretary
of Human Services shall consider the potential of hospital
admittance, emergency room utilization deductions, need for
social services and increased access to quality care.
Section 2. This act shall take effect in 60 days.
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