40 Pa.C.S. Ch. 48

40 Pa.C.S. Ch. 48
in effect

40 Pa.C.S. § 4802 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: "Agreement with the Department of Human Services." As follows: (1) An agreement between an MA or CHIP managed care plan and the Department of Human Services to manage the purchase and provision of services. (2) The term includes a county or multicounty agreement with the Department of Human Services for behavioral health services. "Asynchronous interaction." An exchange of information between a patient and a health care provider that does not occur in real time, including the secure collection and transmission of a patient's medical information, clinical data, clinical images, laboratory results and self-reported medical history. "Children's Health Insurance Program" or "CHIP." The Children's Health Insurance Program under Article XXIII-A of the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921. "Enrollee." An individual who is entitled to receive health care services under an agreement with the Department of Human Services. "Health care facility." As follows: (1) An entity that is licensed to provide a health care service under Article X of the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, or the act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act. (2) A federally qualified health center as defined in 42 U.S.C. § 1395x(aa)(4) (relating to definitions). (3) A rural health clinic as defined in 42 U.S.C. § 1395xx(aa)(2). "Health care provider." A health care facility, medical equipment supplier or person that is licensed, certified or otherwise regulated to provide health care services under the laws of this Commonwealth or another state. "Health care service." Any treatment, admission, procedure, medical supplies and equipment or other services, including behavioral health, prescribed or otherwise provided or proposed to be provided by a health care provider to a patient for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease. "Health Information Technology for Economic and Clinical Health Act." The Health Information Technology for Economic and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496). "Health insurance policy." As follows: (1) A policy, subscriber contract, certificate or plan issued by an insurer that provides medical or health care coverage. (2) The term includes a dental only and a vision only policy. (3) The term does not include: (i) An accident only policy. (ii) A credit only policy. (iii) A long-term care or disability income policy. (iv) A specified disease policy. (v) A Medicare supplement policy. (vi) A TRICARE policy, including a Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement policy. (vii) A fixed indemnity policy. (viii) A hospital indemnity policy. (ix) A worker's compensation policy. (x) An automobile medical payment policy under 75 Pa.C.S. (relating to vehicles). (xi) A homeowner's insurance policy. (xii) Any other similar policies providing for limited benefits. "Health Insurance Portability and Accountability Act of 1996." The Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936). "Insurer." An entity licensed by the department that offers, issues or renews a health insurance policy and is governed under any of the following: (1) The Insurance Company Law of 1921, including section 630 and Article XXIV of that act. (2) The act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act. (3)

40 Pa.C.S. § 4803 Insurance coverage of telemedicine.

(a) General rule.-- (1) A health insurance policy offered, issued or renewed in this Commonwealth shall provide coverage for medically necessary health care services provided through telemedicine and delivered by a participating network provider who provides a covered health care service through telemedicine consistent with the insurer's medical policies. A health insurance policy may not exclude a health care service from coverage solely because the health care service is provided through telemedicine. (2) Subject to paragraph (1), an insurer shall pay or reimburse a participating network provider for covered health care services delivered through telemedicine and pursuant to a health insurance policy in accordance with the terms and conditions of the contract as negotiated between the insurer and the participating network provider. A contract that includes payment or reimbursement for covered health care services delivered through telemedicine may not prohibit payment or reimbursement solely because a health care service is provided by telemedicine. Payment or reimbursement may not be conditioned upon the use of an exclusive or proprietary telemedicine technology or vendor. (b) Applicability.-- (1) Subsection (a) does not apply if the telemedicine-enabling device, technology or service fails to comply with the Health Insurance Portability and Accountability Act of 1996, the Health Information Technology for Economic and Clinical Health Act or other applicable statute, regulation or guidance. (2) For a health insurance policy for which either rates or forms are required to be filed with the Federal Government or the department, this section shall apply to a policy for which a form or rate is first filed on or after 180 days after the effective date of this paragraph. (3) For a health insurance policy for which neither rates nor forms are required to be filed with the Federal Government or the department, this section shall apply to a policy issued or renewed on or after 180 days after the effective date of this paragraph. (c) Construction.--This section may not be construed to: (1) Prohibit an insurer from paying or reimbursing other health care providers for covered health care services provided through telemedicine. (2) Require an insurer to pay or reimburse an out-of-network health care provider for health care services provided through telemedicine. (3) Require an insurer to pay or reimburse a participating network provider if the provision of the health care service through telemedicine would be inconsistent with the standard of care.

40 Pa.C.S. § 4804 Medical assistance and children's health insurance program coverage.

(a) MA or CHIP managed care plan payment.-- (1) MA or CHIP managed care plan payments shall be made on behalf of enrollees for medically necessary health care services provided through telemedicine, if all of the following apply: (i) The health care service would be covered through an in-person encounter. (ii) The provision of the health care service through telemedicine is consistent with Federal law and regulations, the laws of this Commonwealth, applicable regulations and guidance. (iii) Federal approval, if necessary for the provision of the health care service through telemedicine, has been received by the Department of Human Services. (2) The MA or CHIP managed care plan shall pay a participating network provider for covered health care services delivered through telemedicine in accordance with the terms and conditions of both: (i) the contract negotiated between the MA or CHIP managed care plan and the participating network provider; and (ii) the agreement with the Department of Human Services. (b) Applicability.-- (1) Subsection (a) does not apply if the telemedicine-enabling device, technology or service fails to comply with the Health Insurance Portability and Accountability Act of 1996, the Health Information Technology for Economic and Clinical Health Act or other applicable statute, regulation or guidance from the Federal Government or the Department of Human Services. (2) This section shall apply to MA and CHIP managed care plans beginning on or after January 1, 2026. (c) Construction.--This section may not be construed to: (1) Prohibit a MA or CHIP managed care plan from making payments on behalf of enrollees to other health care providers for covered health care services provided through telemedicine. (2) Require a MA or CHIP managed care plan to pay for a health care service if the delivery of the health care service through telemedicine would be inconsistent with the standard of care.

40 Pa.C.S. § 4805 Standard of care.

A health care provider providing health care services through telemedicine shall be subject to the same standard of care that would apply to the health care services in an in-person setting.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=40Fetched: 10/16/2026

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