PRINTER'S NO. 1728

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1512

Session of

2023

INTRODUCED BY SAPPEY, HILL-EVANS, HANBIDGE, D. WILLIAMS,

ISAACSON, BURGOS, MADDEN, GUENST, SANCHEZ, CIRESI, KINSEY,

SCHLOSSBERG, VENKAT, GALLOWAY, HOHENSTEIN, SAMUELSON, DEASY,

Statutes, in regulation of insurers and related persons

generally, providing for telemedicine.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Title 40 of the Pennsylvania Consolidated

Statutes is amended by adding a chapter to read:

Sec.

4501. Definitions.

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Covered person." A policyholder, subscriber or other

individual who is entitled to receive a covered health care

service under a health insurance policy.

"Health care provider." Any of the following:

(1) A health care practitioner as defined in section 103

of the act of July 19, 1979 (P.L.130, No.48), known as the

Health Care Facilities Act.

(2) A federally qualified health center as defined in 42

prevention, treatment, habilitation, rehabilitation, cure or

relief of a health condition, injury, disease or illness.

"Health insurance policy." As follows:

(1) A policy, subscriber contract, certificate or plan

issued by a health insurer that provides medical or health

care coverage.

(2) 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.

(viii) A vision only policy.

(ix) A workers' compensation policy.

(x) An automobile medical payment policy.

(xi) A policy under which benefits are provided by

the Federal Government to active or former military

personnel and their dependents.

(xii) A hospital indemnity policy.

(xiii) Any other similar policies providing for

limited benefits.

"Health insurer." An entity that holds a valid license

(2) The act of December 29, 1972 (P.L.1701, No.364),

known as the Health Maintenance Organization Act.

(3) Chapter 61 (relating to hospital plan corporations).

(4) Chapter 63 (relating to professional health services

plan corporations).

"Participating health care provider." A health care provider

that has entered into a contractual or operating relationship

with a health insurer to participate in one or more designated

networks of the health insurer and to provide covered health

care services to covered persons under the terms of the

health care provider for diagnostic studies, therapeutic

interventions or other services that may benefit a covered

person who is the patient of the initiator of the consultation.

"Telemedicine." As follows:

(1) The delivery of health care services by a health

care provider who is at a different location, through

technology which satisfies the requirements of the Health

Insurance Portability and Accountability Act of 1996 (Public

Law 104-191, 110 Stat. 1936), the Health Information

Technology for Economic and Clinical Health Act (Public Law

messaging or a combination thereof.

(ii) A provider-to-provider consultation.

§ 4502. Health insurance coverage of telemedicine services.

(a) Requirements.--

(1) The following apply to health insurers:

(i) A health insurer may not refuse to pay or to

reimburse a participating health care provider or a

covered person for a medically necessary covered health

care service provided through telemedicine to a covered

person solely because the health care service was

applicable, the network participation agreement as

negotiated between the insurer and the participating

health care provider.

(2) A health insurance policy offered, issued,

delivered, executed or renewed in this Commonwealth may not

contain a provision that refuses to pay or to reimburse a

participating health care provider or a covered person for a

medically necessary covered health care service provided

through telemedicine to a covered person solely because the

health care service was provided through telemedicine.

technology or vendor.

(b) Construction.--Nothing in this section shall be

construed to require parity between payments or reimbursements

for health care services provided through telemedicine and

payments or reimbursements for health care services provided

through an in-person encounter.

§ 4503. Legal standard of care.

Health care services provided through telemedicine shall meet

the same legal standard of care that would apply if the health

care service were rendered in an in-person setting.

construed to diminish a Commonwealth entity's existing

regulatory authority regarding health insurance policies or the

practice of health care.

§ 4505. Applicability.

(a) Rates or forms required.--For a health insurance policy

for which either rates or forms are required to be filed with

the Federal Government or the department, this chapter 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 subsection.

(b) Rates and forms not required.--For a health insurance