PRINTER'S NO. 902
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
916
Session of
2021
INTRODUCED BY ZABEL, PASHINSKI, HILL-EVANS, FREEMAN,
SCHLOSSBERG, SANCHEZ, T. DAVIS, BURGOS, SHUSTERMAN,
HOHENSTEIN, ISAACSON, WEBSTER, GALLOWAY, D. WILLIAMS,
DELLOSO, O'MARA, N. NELSON, LEWIS DELROSSO, STURLA AND
HOWARD, MARCH 15, 2021
REFERRED TO COMMITTEE ON INSURANCE, MARCH 15, 2021
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, providing
for coverage for nonopioid pain management care.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.8. Coverage for Nonopioid Pain Management
Care.-- (a) A health insurance policy offered, issued or renewed
in this Commonwealth shall include coverage for evidence-based
nonopioid pain management care. Coverage for evidence-based
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nonopioid pain management care shall include, but not be limited
to, the following treatments:
(1) Acupuncture.
(2) Chiropractic care.
(3) Massage therapy.
(4) Occupational therapy.
(5) Osteopathic manipulative treatment.
(6) Physical therapy.
(b) Evidence-based nonopioid pain management care shall be
considered a rehabilitation and habilitation service under the
Patient Protection and Affordable Care Act (Public Law 111-148,
124 Stat. 119) and corresponding regulations.
(c) The coverage required under this section shall not be
subject to annual or lifetime dollar limits on visits for
treatment of pain.
(d) The coverage required under this section shall be
subject to deductibles, coinsurance and copayment requirements
imposed by an insurer subject to this section for similar
coverages under the same health insurance policy.
(e) The amount of health care provider reimbursement by an
insurer for coverage required under this section shall be no
less than seventy-five percent of the billing code rate.
(f) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection:
"Billing code rate" means the cost of a service or procedure
provided by a health care provider that is assigned a numerical
code in order for an insurer to reimburse the health care
provider for that service or procedure.
"Evidence-based" means the conscientious, explicit and
judicious use of current best evidence in making decisions about
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the care of individual patients.
"Health insurance policy" means a policy, subscriber
contract, certificate or plan issued by an insurer that provides
medical or health care coverage. The term does not include the
following policies:
(1) Accident only.
(2) Credit only.
(3) Long-term care or disability income.
(4) Specified disease.
(5) Medicare supplement.
(6) TRICARE , including Civilian Health and Medical Program
of the Uniformed Services (CHAMPUS) supplement.
(7) Fixed indemnity.
(8) Dental only.
(9) Vision only.
(10) Workers' compensation.
(11) Automobile medical payment under 75 Pa.C.S. (relating
to vehicles).
"Nonopioid pain management care" means nonpharmacologic and
pharmacologic modalities or medications as an alternative to
opioid medications for the treatment of mild to moderate acute
and chronic pain.
Section 2. The addition of section 635.8 of the act shall
apply to health insurance policies offered, issued or renewed on
or after the effective date of this section.
Section 3. This act shall take effect in 60 days.
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