A04605
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2268
Session of
2024
INTRODUCED BY MARKOSEK, HARKINS, McNEILL, DONAHUE, PISCIOTTANO,
MULLINS, ABNEY, SANCHEZ, DELLOSO, SCHLOSSBERG, KINSEY,
CONKLIN, MALAGARI, MERCURI AND DEASY, MAY 3, 2024
REFERRED TO COMMITTEE ON INSURANCE, MAY 3, 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 speech therapy for stuttering.
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. Speech Therapy for Stuttering.--(a) An
insurer or MA or CHIP managed care plan shall make available
coverage of both habilitative speech therapy treatment and
rehabilitative speech therapy treatment for childhood stuttering
and neurological stuttering. A health insurance policy offered,
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issued, or renewed in this Commonwealth shall provide coverage
for habilitative speech therapy treatment and rehabilitative
speech therapy treatment for childhood stuttering.
(b) The coverage required under this section :
(1) Shall not be subject to any maximum annual benefit
limit, including any limit on the number of visits that an
insured individual may make to a speech-language pathologist.
(2) Shall not be limited based on the type of disease,
injury, disorder or other medical condition that resulted in
stuttering.
(3) Shall not be limited to cases of childhood stuttering.
(4) Shall not be subject to utilization review requirements,
including prior authorization.
(5) Shall include both in-person and telehealth speech
therapy treatment.
(c) If the secretary determines that a waiver or other
authorization from a Federal agency is necessary to implement
coverage required under this section, the secretary shall
request the waiver or other authorization within ninety days
after the effective date of this subsection. Implementation of
this section shall only be delayed by the requirement for the
secretary to secure the necessary waiver or other authorization.
(d) As used in this section: shall be subject to the terms
and conditions of a health insurance policy, including
provisions relating to medical necessity, cost-sharing and
utilization review.
(c) This section shall not be construed to require an
insurer to cover school-based speech therapy for childhood
stuttering based solely on inclusion of the therapy in an
individualized education program.
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(d) (1) Except as provided in paragraph (2), the terms in
this section shall be given the same meaning as in section 2102
of this act.
(2) As used in this section, the following words and phrases
shall have the meanings given to them in this paragraph unless
the context clearly indicates otherwise:
"Childhood stuttering" means a speech disorder characterized
by repetition of sounds, syllables or words, prolongation of
sounds and interruptions in speech developed between two and six
years of age.
"Cost-sharing" means:
(1) The share of the health care costs covered by a health
insurance policy that an enrollee or covered person pays out-of-
pocket.
(2) The term includes a deductible, coinsurance, copayment
or similar charge.
(3) The term does not include a premium, a balance billed
amount from an out-of-network provider or the cost of a
noncovered service.
"Habilitative speech therapy treatment" means speech therapy
that helps an individual to keep, learn or improve skills and
functioning for daily living.
"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 any
of the following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
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(5) A Medicare supplement policy.
(6) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS) supplement
policy.
(7) A fixed indemnity policy.
(8) A hospital indemnity policy.
(9) A dental only policy.
(10) A vision only policy.
(11) A workers' compensation policy.
(12) An automobile medical payment policy under 75 Pa.C.S.
(relating to vehicles).
(13) A homeowners' insurance policy.
(14) Any other similar policy providing for limited
benefits.
"Insurer" means as follows:
(1) An entity licensed by the Insurance 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).
(2) The term does not include an entity operating as an MA
or CHIP managed care plan.
"MA or CHIP managed care plan" 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
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health care services.
"Neurological stuttering" means a speech disorder
characterized by repetition of sounds, syllables or words,
prolongation of sounds and interruptions in speech developed as
a result of a stroke, head trauma or other type of brain injury.
"Prior authorization" means a prospective utilization review,
performed by an insurer or MA or CHIP managed care plan or by a
utilization review entity acting on behalf of an insurer or MA
or CHIP managed care plan, of all reasonably necessary
supporting information that occurs prior to the delivery or
provision of a health care service and results in a decision to
approve or deny payment for the health care service. The term
includes step therapy and step therapy exception requests.
"Rehabilitative speech therapy treatment" means speech
therapy that helps an individual restore or improve skills and
functioning for daily living that have been lost or impaired.
"Secretary" means the Secretary of Human Services of the
Commonwealth.
"Speech therapy" means the therapeutic care provided to an
individual for treatment administered by a licensed speech-
language pathologist.
"Telehealth" means the application of telecommunication
technology to deliver speech therapy services at a distance for
assessment, intervention or consultation.
"Utilization review" means a set of formal techniques
designed to monitor the use of or evaluate the medical
necessity, appropriateness, efficacy or efficiency of health
care services, procedures or settings, including prior
authorization, second opinion, certification, concurrent review,
case management, discharge planning or retrospective review, in
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order to make a determination regarding coverage of the service
under the terms of a health insurance policy or an agreement
with the Department of Human Services.
Section 2. This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
180 days after the effective date of this paragraph.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this act shall apply
to any policy issued or renewed on or after 180 days after
the effective date of this paragraph.
Section 3. This act shall take effect in 90 60 days.
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