Pennsylvania HB 1445: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for school-based services; and, in telemedicine, further providing for insurance coverage of telemedicine.

Bill Text

PRINTER'S NO. 1897
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1445
Session of
2025
INTRODUCED BY WARREN, BRENNAN, MALAGARI, HILL-EVANS, SANCHEZ,
VITALI, PIELLI, HOHENSTEIN, SCHLOSSBERG, NEILSON, MERSKI AND
D. WILLIAMS, JUNE 10, 2025
REFERRED TO COMMITTEE ON INSURANCE, JUNE 10, 2025
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for school-based services; and, in
telemedicine, further providing for insurance coverage of
telemedicine.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 44
SCHOOL-BASED SERVICES
Sec.
4401. Legislative findings and intent.
4402. Definitions.
4403. Insurance coverage for health care service in school
setting.
4404. Permitted exclusions.
4405. Coordination of benefits.
4406. Construction.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

4407. Regulations.
4408. Penalties.
4409. Administrative procedures.
§ 4401. Legislative findings and intent.
(a) Legislative findings.--The General Assembly finds and
declares as follows:
(1) Health care services, including mental health
services, may be available to students in a school setting.
(2) Educational opportunities for students will be
maximized if students are able to access health care services
without leaving their school setting.
(b) Intent.--The intent of this chapter is to maximize
educational opportunities for students by establishing
limitations on when health insurance coverage for health care
services provided in a school setting may be excluded or denied.
§ 4402. 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:
"Administrative policy." A written document or collection of
documents reflecting the terms of the contractual or operating
relationship between an insurer and a health care provider.
"Clinical review criteria." The set of written screening
procedures, decision abstracts, clinical protocols and practice
guidelines used by an insurer to determine the necessity and
appropriateness of health care services.
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive health care services under
20250HB1445PN1897 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

a health insurance policy.
"Habilitative speech therapy." Speech therapy that helps an
individual to keep, learn or improve skills and function for
daily living.
"Health care provider." A person that is licensed,
certified, registered or otherwise permitted by law or
regulation to provide health care services under the laws of
this Commonwealth.
"Health care service." A treatment, procedure, medical
supply or other service prescribed or otherwise provided or
proposed to be provided by a health care provider to a covered
person for any of the following:
(1) mental health;
(2) behavioral health; or
(3) speech therapy.
"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 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 policy under which benefits are provided by
the Federal Government to active or former military
personnel and their dependents, including a Tricare
policy or a Civilian Health And Medical Program of the
Uniformed Services (CHAMPUS) supplement policy.
20250HB1445PN1897 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

(vii) A fixed indemnity policy.
(viii) A hospital indemnity policy.
(ix) A dental only policy.
(x) A vision only policy.
(xi) A workers' compensation policy.
(xii) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(xiii) A homeowner's insurance policy.
(xiv) Any other similar policies providing for
limited benefits.
"Insurer." An entity licensed by the department that offers,
issues or renews an individual or group health insurance policy
that is offered or governed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV thereof.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) Chapter 61 (relating to hospital plan corporations)
or 63 (relating to professional health services plan
corporations).
"Medical policy." A written document adopted, maintained and
applied by an insurer that combines the clinical review criteria
and any additional administrative policy, as applicable,
necessary to articulate the insurer's st