PRINTER'S NO. 2480
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1823
Session of
2017
INTRODUCED BY MASSER, MILLARD, SCHLOSSBERG, TALLMAN, O'NEILL,
A. HARRIS, GROVE, FARRY, HEFFLEY, WHEELAND, WATSON, WARD AND
GABLER, SEPTEMBER 26, 2017
REFERRED TO COMMITTEE ON INSURANCE, SEPTEMBER 26, 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 casualty insurance, further
providing for billing.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 635.7 of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921,
added December 20, 2015 (P.L.461, No.84), is amended to read:
Section 635.7. Billing.--(a) When an EMS agency is
dispatched by a public safety answering point as defined in 35
Pa.C.S. § 5302 (relating to definitions) or an EMS agency
dispatch center under 35 Pa.C.S. § 8129(i) (relating to
emergency medical services agencies) for an emergency and
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
provides medically necessary emergency medical services, a
payment made by an insurer for a claim covered under and in
accordance with a health insurance policy for an emergency
medical service performed by the EMS agency during the call
shall be paid directly to the EMS agency.
[(b) An insurer must reimburse a nonnetwork EMS agency under
the following:
(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 electronic registry that indicates which EMS
agency has requested nonnetwork direct reimbursement from an
insurer identified on the form.
(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) An EMS agency may be subject to periodic audits by an
insurer to examine claims for direct reimbursement under this
section. If, through the audit, the insurer identifies an
improper payment, the insurer may deduct the improper payment
from future reimbursements.
[(d) Where an insurer has reimbursed a nonnetwork EMS agency
20170HB1823PN2480 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
at the same rate it has established for a network EMS agency,
the EMS agency 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) An EMS agency that submits a form under this section may
solicit donations or 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). 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) Claims paid under this section shall be subject to
section 2166.
(g) This section shall apply only to an EMS agency that is a
nonnetwork provider and provides emergency medical services,
unless preempted by Federal law.
(h) The following words and phrases when used in this
section shall have the meanings given to them in this subsection
unless the context clearly indicates otherwise:
["Department." Department of Health of the Commonwealth.]
"EMS agency." As defined in 35 Pa.C.S. § 8103 (relating to
definitions).
"Emergency medical services." As defined in 35 Pa.C.S. §
8103 (relating to definitions).
"Insurer." As follows:
20170HB1823PN2480 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(1) An entity that is responsible for providing or paying
for all or part of the cost of emergency medical services
covered by an insurance policy, contract or plan. The term
includes an entity subject to:
(i) section 630, Article XXIV or any other provision of this
act;
(ii) the act of December 29, 1972 (P.L.1701, No.364), known
as the Health Maintenance Organization Act; or
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(2) The term does not include an entity that is responsible
for providing or paying under an insurance policy, contract or
plan which meets any of the following:
(i) Is a homeowner's insurance policy.
(ii) Provides any of the following types of insurance:
(A) Accident only.
(B) Fixed indemnity.
(C) Limited benefit.
(D) Credit.
(E) Dental.
(F) Vision.
(G) Specified disease.
(H) Medicare supplement.
(I) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(J) Long-term care.
(K) Disability income.
(L) Workers' compensation.
(M) Automobile medical payment insurance.
20170HB1823PN2480 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Section 2. This act shall take effect in 60 days.
20170HB1823PN2480 - 5 -
1