HB 2315
An Act amending the act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act, further providing for rules and regulations.
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Sign in to take action- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill amends the Health Maintenance Organization Act in Pennsylvania to ensure that health maintenance organizations (HMOs) do not deny payment for basic health services or physician services simply because a referral was made by a direct primary care provider. The bill defines ‘direct primary care provider’ as a licensed physician or other advanced health care practitioner who provides direct health care services through an agreement with a patient. The legislation directs the Insurance Commissioner and Secretary of Health to create regulations regarding this issue within one year.
Key provisions
- Defines ‘direct primary care provider’ as a licensed physician or other advanced health care practitioner.
- Requires HMOs not to deny payment for services based solely on the referral source being a direct primary care provider.
- Authorizes the Insurance Commissioner and Secretary of Health to create rules and regulations related to this issue.
- Sets a one-year timeframe for the creation of these regulations.
Who is affected
- Health Maintenance Organizations (HMOs)
- Patients receiving care from direct primary care providers
- Direct Primary Care Providers
- Insurance Commissioner
- Secretary of Health
Notable changes
- Requires HMOs to accept referrals from direct primary care providers without penalty.
- Introduces a formal definition of ‘direct primary care provider’ for regulatory purposes.
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
Benjamin Sanchez
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