HB 1152 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, further providing for billing.

PRINTER'S NO.   1272

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1152
                                               Session of
                                                 2025

     INTRODUCED BY COOPER, ABNEY, BANTA, BENHAM, BERNSTINE, BOROWSKI,
        BOYD, M. BROWN, CAUSER, DAVANZO, DEASY, FLICK, FLOOD,
        FRANKEL, FRITZ, GREEN, GUENST, JAMES, KULIK, KUZMA, MAJOR,
        McANDREW, O'MARA, OLSOMMER, PIELLI, PROBST, PUGH, RADER,
        REICHARD, SMITH, STEELE, VENKAT AND D. WILLIAMS,
        APRIL 4, 2025

     REFERRED TO COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
        PREPAREDNESS, APRIL 4, 2025


                                    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," in casualty insurance, further
12      providing for billing.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15      Section 1.    Section 635.7(b), (d), (e) and (g) of the act of
16   May 17, 1921 (P.L.682, No.284), known as The Insurance Company
17   Law of 1921, are amended and the section is amended by adding
18   subsections to read:
19      Section 635.7.    Billing.--* * *
20      [(b)   An insurer must reimburse a nonnetwork EMS agency under
 1   the following:
 2      (1)   The EMS agency has submitted a completed standardized
 3   form to the department requesting nonnetwork direct
 4   reimbursement from an insurer an EMS agency has identified. The
 5   form must be submitted to the department annually by October 15.
 6   The form shall declare the EMS agency's intention to receive
 7   direct payment from an insurer identified on the form for the
 8   next calendar year. The department shall develop a standardized
 9   form, using an EMS agency's assigned license number, to be used
10   by an EMS agency that meets the conditions established under
11   this section. The department shall develop and maintain a
12   publicly accessible electronic registry that indicates which EMS
13   agency has requested nonnetwork direct reimbursement from an
14   insurer identified on the form.
15      (2)   An EMS agency has provided notification to the insurer
16   upon submitting a claim for reimbursement that the EMS agency is
17   registered with the department to receive direct reimbursement
18   as provided for under this section.]
19      (b.1)   An EMS agency may seek reimbursement and shall accept
20   payment from an insurer for services that have been provided to
21   a covered person for dispatched 911 emergency medical services.
22      (b.2)   Upon receiving a bill for dispatched 911 emergency
23   medical services, an insurer shall directly reimburse a
24   designated EMS agency within forty-five days at three hundred
25   fifty percent of the current published rate for ambulance
26   services as established by the Centers for Medicare and Medicaid
27   Services under 42 U.S.C. Ch. 7 Subch. XVIII (relating to health
28   insurance for aged and disabled) for the same service provided
29   in the same geographic area and according to:
30      (1)   The allowable amount afforded under this section only

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 1   applies to dispatched 911 emergency medical services and does
 2   not apply to any other covered service provided by a
 3   participating network provider under a health insurance policy.
 4      (2)     Payment made by the insurer in compliance with this
 5   section shall be considered payment in full for the service
 6   provided, except for any copayment, coinsurance, deductible or
 7   other cost-sharing amounts required to be paid by the covered
 8   person.
 9      (3)     An EMS agency may not bill the covered person directly
10   or indirectly or otherwise attempt to collect from a covered
11   person, except to recover a cost-sharing amount.
12      (4)     An insurer may not require an EMS agency to contract
13   with the insurer to receive reimbursement under this section.
14      * * *
15      [(d)     Where an insurer has reimbursed a nonnetwork EMS agency
16   at the same rate it has established for a network EMS agency,
17   the EMS agency may not bill the insured directly or indirectly
18   or otherwise attempt to collect from the insured for the service
19   provided, except for a billing to recover a copayment,
20   coinsurance or deductible as specified in the health insurance
21   policy.]
22      (e)     An EMS agency [that submits a form under this section]
23   may solicit donations or memberships or conduct fundraising,
24   except that an EMS agency may not promise, suggest or infer to
25   donors that a donation will result in the donor not being billed
26   directly for any payment as provided under this section.
27   Notwithstanding this paragraph, an EMS agency may bill in
28   accordance with subsection [(d)] (b.2)(3). A violation of this
29   section shall be considered a violation of the act of December
30   17, 1968 (P.L.1224, No.387), known as the "Unfair Trade

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1   Practices and Consumer Protection Law."
2      * * *
3      [(g)    This section shall apply only to an EMS agency that is
4   a nonnetwork provider and provides emergency medical services,
5   unless preempted by Federal law.]
6      * * *
7      Section 2.   This act shall take effect in 60 days.




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