HB 1965 — An Act amending Title 35 (Health and Safety) of the Pennsylvania Consolidated Statutes, providing for certification of community paramedicine providers, for community paramedicine service coverage by casualty insurance carriers and for medical assistance reimbursement.

PRINTER'S NO.   2479

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1965
                                                 Session of
                                                   2025

     INTRODUCED BY BIZZARRO, HILL-EVANS, VENKAT, CEPEDA-FREYTIZ,
        BOROWSKI, KHAN, SANCHEZ, MADDEN AND CIRESI, OCTOBER 17, 2025

     REFERRED TO COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
        PREPAREDNESS, OCTOBER 17, 2025


                                      AN ACT
 1   Amending Title 35 (Health and Safety) of the Pennsylvania
 2      Consolidated Statutes, providing for certification of
 3      community paramedicine providers, for community paramedicine
 4      service coverage by casualty insurance carriers and for
 5      medical assistance reimbursement.
 6      The General Assembly of the Commonwealth of Pennsylvania
 7   hereby enacts as follows:
 8      Section 1.    Part III of Title 35 of the Pennsylvania
 9   Consolidated Statutes is amended by adding a chapter to read:
10                                  CHAPTER 41
11                      COMMUNITY PARAMEDICINE SERVICES
12   Subchapter
13      A.   Preliminary Provisions
14      B.   Community Paramedicine Services
15      C.   Financial Provisions
16                               SUBCHAPTER A
17                          PRELIMINARY PROVISIONS
18   Sec.
19   4101.   Definitions.
 1   § 4101.    Definitions.
 2      The following words and phrases when used in this chapter
 3   shall have the meanings given to them in this section unless the
 4   context clearly indicates otherwise:
 5      "Community paramedicine provider."     An individual who is
 6   certified as an EMS provider with additional training under 28
 7   Pa. Code Pt. VII (relating to emergency medical services) and
 8   who has successfully completed an education program for
 9   community paramedicine health care as prescribed by the
10   department by regulation. A community paramedicine provider
11   shall also be considered a "community health worker" for
12   purposes under 42 U.S.C. § 280g-11 (relating to awards to
13   support community health workers and community health).
14      "Community paramedicine services."     Services, provided by
15   certified EMS providers acting within their scope of practice
16   under 28 Pa. Code Pt. VII, to provide outreach, injury and
17   illness prevention and assistance, based on local need, to
18   patients who do not require emergency medical transportation.
19      "Department."     The Department of Health of the Commonwealth.
20      "Emergency medical services agency medical director" or "EMS
21   agency medical director."     As defined in section 8103 (relating
22   to definitions).
23      "Emergency medical services provider" or "EMS provider."       As
24   defined in section 8103.
25      "Health insurance policy."     As follows:
26             (1)   An individual or group health insurance policy,
27      subscriber contract, certificate or plan that provides
28      medical or health care coverage by any health care facility
29      or licensed health care provider that is offered by or is
30      governed under the act of May 17, 1921 (P.L.682, No.284),

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 1      known as The Insurance Company Law of 1921, or any of the
 2      following:
 3                    (i)    Subarticle (f) of Article IV of the act of June
 4             13, 1967 (P.L.31, No.21), known as the Human Services
 5             Code.
 6                    (ii)    The act of December 29, 1972 (P.L.1701,
 7             No.364), known as the Health Maintenance Organization
 8             Act.
 9                    (iii)    A nonprofit corporation subject to 40 Pa.C.S.
10             Ch. 61 (relating to hospital plan corporations) or 63
11             (relating to professional health services plan
12             corporations).
13             (2)    The term includes a Medicare supplement policy.
14      "Physician."          As defined in section 8103.
15                                     SUBCHAPTER B
16                            COMMUNITY PARAMEDICINE SERVICES
17   Sec.
18   4111.   Certification.
19   4112.   Status.
20   4113.   Regulations.
21   § 4111.    Certification.
22      An individual who is certified for any of the types of EMS
23   providers enumerated under section 8113(a) (relating to
24   emergency medical services providers) shall be permitted to
25   provide community paramedicine services, subject to disciplinary
26   action under section 8121 (relating to certification sanctions).
27   § 4112.    Status.
28      A community paramedicine provider shall be deemed an
29   emergency medical services provider for purposes of Chapter 81
30   (relating to emergency medical services system).

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 1   § 4113.    Regulations.
 2      Within one year of the effective date of this section, the
 3   department shall promulgate regulations to carry out the
 4   provisions of this chapter. The regulations shall establish
 5   certification, practice, disciplinary and other standards
 6   consistent with the purposes of this chapter and with the
 7   requirements applicable to EMS providers, except as necessary to
 8   meet the need for community paramedicine providers.
 9                                 SUBCHAPTER C
10                             FINANCIAL PROVISIONS
11   Sec.
12   4121.    Casualty insurance coverage.
13   4122.    Medical assistance reimbursement.
14   § 4121.    Casualty insurance coverage.
15      (a)    Coverage.--A health insurance policy delivered, issued,
16   executed or renewed in this Commonwealth on or after the
17   effective date of this section shall provide coverage for
18   community paramedicine services.
19      (b)    Copayments, coinsurance and deductible amounts.--
20   Coverage under this chapter shall remain subject to any
21   copayment, coinsurance or deductible amounts provided for in the
22   policy.
23      (c)    Prerequisites for coverage.--To qualify for coverage
24   under this chapter, community paramedicine services must be part
25   of a care plan ordered by an EMS agency medical director,
26   primary health care provider or health insurer as follows:
27             (1)   The care plan should ensure that community
28      paramedicine services provided by a community paramedicine
29      provider are coordinated with other community resources where
30      available.

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 1             (2)   Community paramedicine services shall not duplicate
 2      services already provided to the patient.
 3             (3)   Community paramedicine services shall include the
 4      following:
 5                   (i)    Coordination of community services.
 6                   (ii)    Health assessment.
 7                   (iii)    Chronic disease monitoring and education.
 8                   (iv)    Medication compliance.
 9                   (v)    Hospital discharge follow-up care.
10                   (vi)    Minor medical procedures ordered by an
11             emergency medical services agency medical director or
12             primary health care provider.
13                   (vii)    Such other services as approved by regulation
14             of the department.
15      (d)    Duty of Department of Human Services.--The Department of
16   Human Services shall seek such waivers or Federal approvals as
17   may be necessary to ensure that actions taken under this section
18   comply with applicable Federal law.
19      (e)    Nonapplicability.--This section shall not apply to the
20   following types of policies:
21             (1)   Limited benefit.
22             (2)   Credit.
23             (3)   Dental.
24             (4)   Vision.
25             (5)   Long-term care or disability income.
26   § 4122.    Medical assistance reimbursement.
27      (a)    Duty of Secretary of Human Services.--The Secretary of
28   Human Services shall, in consultation with the department and
29   representatives of emergency medical services providers,
30   physicians and local public health agencies, determine specified

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 1   services and payment rates for community paramedicine services
 2   performed by community paramedicine providers under this chapter
 3   that are to be covered by medical assistance under the laws of
 4   this Commonwealth.
 5      (b)   Payment.--
 6            (1)   Payment for community paramedicine services under
 7      this chapter must be part of a care plan ordered by a primary
 8      health care provider or emergency medical services agency
 9      medical director of an ambulance service and must be billed
10      by an eligible provider enrolled in medical assistance that
11      employs or contracts with the community paramedicine
12      provider.
13            (2)   In determining the community paramedicine services
14      to include under medical assistance coverage, the Secretary
15      of Human Services shall consider the potential of hospital
16      admittance, emergency room utilization deductions, need for
17      social services and increased access to quality care.
18      Section 2.    This act shall take effect in 60 days.




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