THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY MURT, CREIGHTON, DALEY, DONATUCCI, HARKINS, HORNAMAN, JOSEPHS, KILLION, KOTIK, MAHONEY, PICKETT, RAPP, READSHAW, SCHRODER, STEVENSON, STURLA, THOMAS, VULAKOVICH AND YOUNGBLOOD, DECEMBER 20, 2011

REFERRED TO COMMITTEE ON INSURANCE, DECEMBER 20, 2011  

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," providing for acquired brain injury

disclosure.

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 635.6.  Acquired Brain Injury Disclosure.--(a)  Every

insurer shall supply each insured and enrollee and each

prospective insured and enrollee with the following written

information upon request. The information shall be easily

understandable by the layperson and shall include all of the

following:

(1)  A description of coverage which includes the following:

(i)  Behavioral optometry or vision therapy.

(ii)  Case management.

(iii)  Cognitive communication therapy.

(iv)  Cognitive rehabilitation therapy.

(v)  Cognitive remediation.

(vi)  Community integration therapy.

(vii)  Family education and counseling.

(viii)  Hyperbaric oxygen therapy.

(ix)  Neurobehavioral testing.

(x)  Evaluation and treatment.

(xi)  Neurocognitive therapy and rehabilitation.

(xii)  Neuropsychological testing, evaluation and treatment.

(xiii)  Neuropsychiatric evaluation and treatment.

(xiv)  Neurofeedback therapy.

(xv)  Occupational therapy.

(xvi)  Physical therapy.

(xvii)  Post-acute transition services.

(xviii)  Speech and language therapy.

(xix)  Vision biofeedback.

(2)  A description of coverage, benefits and benefit maximums

related to an acquired brain injury treatment and

rehabilitation, including benefit limitations and exclusions of

coverage, health care services and the definition of medical

necessity used by the plan in determining whether these benefits

will be covered.

(3)  A description of all necessary prior authorizations.

(4)  A description of an insurer's personnel responsible for

case management and prior authorizations of an insured or

enrollee with an acquired brain injury.

(5)  Other information as may be required by the department.

(b)  The department, in consultation with the Department of

Health's Traumatic Brain Injury Advisory Board, shall promulgate

regulations concerning the specific contents and wording of the

notice required under this section.

(c)  For purposes of this section, the following words and

phrases shall have the meanings given to them in this subsection

unless the context clearly indicates otherwise:

"Acquired brain injury."  The cognitive, intellectual,

emotional, behavioral and physical effects of a traumatic or

nontraumatic injury to the brain. The term does not include

inherited, congenital or degenerative conditions.

"Department" means the Insurance Department of the

Commonwealth.

"Health insurance policy" means any group health, sickness or

accident policy or subscriber contract or certificate issued by

an entity subject to any of the following:

(1)  This act.

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

as the "Health Maintenance Organization Act."

(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health services

plan corporations).

"Insurer" means any entity that issues an individual or group

health insurance policy, contract or plan described under the

definition of health insurance policy.

Section 2.  This act shall take effect in 60 days.