PRINTER'S NO. 3698
No. 2570 Session of 2002
INTRODUCED BY MACKERETH, R. MILLER, THOMAS, BARRAR, BELFANTI,
CLARK, COLEMAN, CREIGHTON, FAIRCHILD, FREEMAN, GABIG, GEORGE,
HARPER, HERMAN, HORSEY, LEWIS, MARSICO, McGILL, MELIO,
NAILOR, NICKOL, PICKETT, RUBLEY, SAYLOR, SCHRODER, B. SMITH,
SOLOBAY, STEELMAN, STURLA, E. Z. TAYLOR, TIGUE, TRELLO,
WASHINGTON, WATSON AND YOUNGBLOOD, APRIL 16, 2002
REFERRED TO COMMITTEE ON INSURANCE, APRIL 16, 2002
AN ACT
1 Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
2 act relating to insurance; amending, revising, and
3 consolidating the law providing for the incorporation of
4 insurance companies, and the regulation, supervision, and
5 protection of home and foreign insurance companies, Lloyds
6 associations, reciprocal and inter-insurance exchanges, and
7 fire insurance rating bureaus, and the regulation and
8 supervision of insurance carried by such companies,
9 associations, and exchanges, including insurance carried by
10 the State Workmen's Insurance Fund; providing penalties; and
11 repealing existing laws," further providing for emergency
12 services.
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. Section 2116 of the act of May 17, 1921 (P.L.682,
16 No.284), known as The Insurance Company Law of 1921, added June
17 17, 1998 (P.L.464, No.68), is amended to read:
18 Section 2116. Emergency Services.--(a) If an enrollee seeks
19 emergency services and the emergency health care provider
20 determines that emergency services are necessary, the emergency
21 health care provider shall initiate necessary intervention to
1 evaluate and, if necessary, stabilize the condition of the
2 enrollee without seeking or receiving authorization from the
3 managed care plan. The managed care plan shall pay all
4 reasonably necessary costs associated with the emergency
5 services provided during the period of the emergency. When
6 processing a reimbursement claim for emergency services, a
7 managed care plan shall consider both the presenting symptoms
8 and the services provided. The emergency health care provider
9 shall notify the enrollee's managed care plan of the provision
10 of emergency services and the condition of the enrollee. If an
11 enrollee's condition has stabilized and the enrollee can be
12 transported without suffering detrimental consequences or
13 aggravating the enrollee's condition, the enrollee may be
14 relocated to another facility to receive continued care and
15 treatment as necessary.
16 (b) This section shall apply to preferred provider
17 organizations that do not require the use of a gatekeeper and to
18 policyholders, subscribers, covered persons or other individuals
19 who are entitled to receive health care services under such a
20 plan.
21 Section 2. This act shall take effect in 60 days.
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