Bill Summary – FastDemocracy

PRINTER'S NO.   3247
                     THE GENERAL ASSEMBLY OF PENNSYLVANIA
                         HOUSE BILL
                         No. 2385
                                               Session of
                                                 2024
     INTRODUCED BY POWELL, HILL-EVANS, GIRAL, CONKLIN, SANCHEZ AND
        DONAHUE, JUNE 5, 2024
     REFERRED TO COMMITTEE ON INSURANCE, JUNE 5, 2024
                                    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 interprofessional consultation.
    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 635.9.    Coverage for Interprofessional
 Consultation.--(a)    Except to the extent already covered under
 another policy, a health insurance policy offered, issued or
 renewed in this Commonwealth shall provide coverage for an
 interprofessional consultation performed by a consulting
 provider for the benefit of a patient if the following
 requirements are satisfied:
    (1)    The health care provider performing the
 interprofessional consultation shall use a technology platform
 that is compliant with the Health Insurance Portability and
 Accountability Act of 1996 and the Health Information Technology
 for Economic and Clinical Health Act.
    (2)    The interprofessional consultation services shall be
 performed consistent with the standard of care.
    (b)    The coverage required under this section shall be
 subject to the annual deductibles, copayments or coinsurance
 requirements.
    (c)    MA or CHIP managed care plan payments shall be made on
 behalf of eligible individuals for interprofessional
 consultations, consistent with Federal law, as specified under
 this act.
    (d)    (1)   The term "asynchronous health record consultation
 services" when used in this section means an exchange of
 information between a treating health care provider and a
 consulting provider that does not occur in real time, including
 the secure collection and transmission of a patient's medical
 information, clinical data, clinical images, laboratory results,
 self-reported medical history, diagnosis advice or treatment
 advice.
    (2)    The term "consulting provider" when used in this section
 means a health care provider who offers expert advice, guidance
 or information in their field of specialty to a treating health
 care provider via an interprofessional consultation.
    (3)    The term "health care provider" when used in this
 section means a person, corporation, facility, institution or
 other entity licensed, certified or approved by the Commonwealth
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 to provide health care or professional medical services. The
 term includes, but is not limited to, a physician, a
 professional nurse, a certified nurse-midwife, podiatrist,
 hospital, nursing home, ambulatory surgical center or birth
 center.
    (4)    The term "health insurance policy" when used in this
 section means a policy, subscriber contract, certificate or plan
 issued by a health insurer that provides medical or health care
 coverage. The term does not include any of the following:
    (i)    An accident only policy.
    (ii)     A credit only policy.
    (iii)     A long-term care or disability income policy.
    (iv)     A specified disease policy.
    (v)    A Medicare supplement policy.
    (vi)     A policy under which benefits are provided by the
 Federal Government to active or former military personnel and
 their dependents.
    (vii)     A fixed indemnity policy.
    (viii)     A hospital indemnity policy.
    (ix)     A dental only policy.
    (x)    A vision only policy.
    (xi)     A workers' compensation policy.
    (xii)     An automobile medical payment policy under 75 Pa.C.S.
 (relating to vehicles).
    (xiii)     Any other similar policies providing for limited
 benefits.
    (5)    The term "Health Information Technology for Economic and
 Clinical Health Act" when used in this section means the Health
 Information Technology for Economic and Clinical Health Act
 (Public Law 111-5, 123 Stat. 226-279 and 467-496).
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    (6)    The term "Health Insurance Portability and
 Accountability Act of 1996" when used in this section means the
 Health Insurance Portability and Accountability Act of 1996
 (Public Law 104-191, 110 Stat. 1936).
    (7)    The term "health insurer" when used in this section
 means an entity licensed by the department that offers, issues
 or renews an individual or group health insurance policy that is
 offered or governed under any of the following:
    (i)    This act, including section 630 and Article XXIV.
    (ii)    The act of December 29, 1972 (P.L.1701, No.364), known
 as the "Health Maintenance Organization Act."
    (iii)    40 Pa.C.S. Ch. 61 (relating to hospital plan
 corporations) or 63 (relating to professional health services
 plan corporations).
    (8)    The term "interprofessional consultation" when used in
 this section means asynchronous health record consultation
 services that provide an assessment and management services in
 which the patient's treating health care provider requests the
 treatment advice of a consulting provider with specialty
 expertise to assist in the diagnosis or management of the
 patient's health care needs without the patient's face-to-face
 contact with the consulting provider.
    (9)    The term "MA or CHIP managed care plan" when used in
 this section means a health care plan that uses a gatekeeper to
 manage the utilization of health care services by medical
 assistance or children's health insurance program enrollees and
 integrates the financing and delivery of health care services.
    (10)    The term "treating health care provider" when used in
 this section means an attending or primary health care provider
 that provides health care services to a patient.
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  Section 2.    This act shall apply as follows:
      (1)   For a health insurance policy for which either rates
  or forms are required to be filed with the Federal Government
  or the Insurance Department, this act shall apply to a policy
  for which a form or rate is first filed on or after 180 days
  after the effective date of this section.
      (2)   For a health insurance policy for which neither
  rates nor forms are required to be filed with the Federal
  Government or the Insurance Department, this act shall apply
  to a policy issued or renewed on or after 180 days after the
  effective date of this section.
  Section 3.    This act shall take effect in 60 days.
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Statutes/Laws affected: 
Printer's No. 3247: P.L.682, No.284