PRINTER'S NO. 113
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
130
Session of
2023
INTRODUCED BY BIZZARRO, MADDEN, KINSEY, CIRESI, VENKAT, SANCHEZ,
HILL-EVANS, OTTEN, KINKEAD, N. NELSON AND D. WILLIAMS,
MARCH 7, 2023
REFERRED TO COMMITTEE ON VETERANS AFFAIRS AND EMERGENCY
PREPAREDNESS, MARCH 7, 2023
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.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 35 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 41
COMMUNITY PARAMEDICINE SERVICES
Subchapter
A. Preliminary Provisions
B. Community Paramedicine Services
C. Financial Provisions
SUBCHAPTER A
PRELIMINARY PROVISIONS
Sec.
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4101. Definitions.
§ 4101. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Community paramedicine provider." An individual who is
certified as an EMS provider with additional training under 28
Pa. Code Pt. VII (relating to emergency medical services) and
who has successfully completed an education program for
community paramedicine health care as prescribed by the
department by regulation. A community paramedicine provider
shall also be considered a "community health worker" for
purposes under 42 U.S.C. § 280g-11 (relating to grants to
promote positive health behaviors and outcomes).
"Community paramedicine services." Services, provided by
certified EMS providers acting within their scope of practice
under 28 Pa. Code Pt. VII, to provide outreach, injury and
illness prevention and assistance, based on local need, to
patients who do not require emergency medical transportation.
"Department." The Department of Health of the Commonwealth.
"Emergency medical services agency medical director" or "EMS
agency medical director." As defined in section 8103 (relating
to definitions).
"Emergency medical services provider" or "EMS provider." As
defined in section 8103.
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
subscriber contract, certificate or plan that provides
medical or health care coverage by any health care facility
or licensed health care provider that is offered by or is
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governed under the act of May 17, 1921 (P.L.682, No.284),
known as The Insurance Company Law of 1921, or any of the
following:
(i) Subarticle (f) of Article IV of the act of June
13, 1967 (P.L.31, No.21), known as the Human Services
Code.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) A nonprofit corporation subject to 40 Pa.C.S.
Ch. 61 (relating to hospital plan corporations) or 63
(relating to professional health services plan
corporations).
(2) The term includes a Medicare supplement policy.
"Physician." As defined in section 8103.
SUBCHAPTER B
COMMUNITY PARAMEDICINE SERVICES
Sec.
4111. Certification.
4112. Status.
4113. Regulations.
§ 4111. Certification.
An individual who is certified for any of the types of EMS
providers enumerated under section 8113(a) (relating to
emergency medical services providers) shall be permitted to
provide community paramedicine services, subject to disciplinary
action under section 8121 (relating to certification sanctions).
§ 4112. Status.
A community paramedicine provider shall be deemed an
emergency medical services provider for purposes of Chapter 81
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(relating to emergency medical services system).
§ 4113. Regulations.
Within one year of the effective date of this section, the
department shall promulgate regulations to carry out the
provisions of this chapter. The regulations shall establish
certification, practice, disciplinary and other standards
consistent with the purposes of this chapter and with the
requirements applicable to EMS providers, except as necessary to
meet the need for community paramedicine providers.
SUBCHAPTER C
FINANCIAL PROVISIONS
Sec.
4121. Casualty insurance coverage.
4122. Medical assistance reimbursement.
§ 4121. Casualty insurance coverage.
(a) General rule.--A health insurance policy delivered,
issued, executed or renewed in this Commonwealth on or after the
effective date of this section shall provide coverage for
community paramedicine services.
(b) Copayments, coinsurance and deductible amounts.--
Coverage under this chapter shall remain subject to any
copayment, coinsurance or deductible amounts set forth in the
policy.
(c) Prerequisites for coverage.--To qualify for coverage
under this chapter, community paramedicine services must be part
of a care plan ordered by an EMS agency medical director,
primary health care provider or health insurer as follows:
(1) The care plan should ensure that community
paramedicine services provided by a community paramedicine
provider are coordinated with other community resources where
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available.
(2) Community paramedicine services shall not duplicate
services already provided to the patient.
(3) Community paramedicine services shall include the
following:
(i) Coordination of community services.
(ii) Health assessment.
(iii) Chronic disease monitoring and education.
(iv) Medication compliance.
(v) Hospital discharge follow-up care.
(vi) Minor medical procedures ordered by an
emergency medical services agency medical director or
primary health care provider.
(vii) Such other services as approved by regulation
of the department.
(d) Duty of Department of Human Services.--The Department of
Human Services shall seek such waivers or Federal approvals as
may be necessary to ensure that actions taken under this section
comply with applicable Federal law.
(e) Nonapplicability.--This section shall not apply to the
following types of policies:
(1) Limited benefit.
(2) Credit.
(3) Dental.
(4) Vision.
(5) Long-term care or disability income.
§ 4122. Medical assistance reimbursement.
(a) Duty of Secretary of Human Services.--The Secretary of
Human Services shall, in consultation with the department and
representatives of emergency medical services providers,
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physicians and local public health agencies, determine specified
services and payment rates for community paramedicine services
performed by community paramedicine providers under this chapter
that are to be covered by medical assistance under the laws of
this Commonwealth.
(b) Payment.--
(1) Payment for community paramedicine services under
this chapter must be part of a care plan ordered by a primary
health care provider or emergency medical services agency
medical director of an ambulance service and must be billed
by an eligible provider enrolled in medical assistance that
employs or contracts with the community paramedicine
provider.
(2) In determining the community paramedicine services
to include under medical assistance coverage, the Secretary
of Human Services shall consider the potential of hospital
admittance, emergency room utilization deductions, need for
social services and increased access to quality care.
Section 2. This act shall take effect in 60 days.
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