Pennsylvania SB 905: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, in regulation of insurers and related persons generally, providing for addiction treatment services information collection and reporting.

Bill Text

PRINTER'S NO. 1023
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 905
Session of
2025
INTRODUCED BY TARTAGLIONE, KANE, COSTA, SANTARSIERO AND SCHWANK,
JUNE 30, 2025
REFERRED TO BANKING AND INSURANCE, JUNE 30, 2025
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for addiction treatment services
information collection and reporting.
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 42
ADDICTION TREATMENT SERVICES INFORMATION
COLLECTION AND REPORTING
Sec.
4201. Scope of chapter.
4202. Definitions.
4203. Reporting by insurer.
4204. Collection of information and report by department.
4205. Subsequent review and report.
4206. Identifying information.
4207. Regulations.
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4208. Expenses.
§ 4201. Scope of chapter.
This chapter relates to the collection and reporting of
statistics regarding addiction treatment services provided under
health plans and insurance policies, contracts and certificates
and compliance with other laws.
§ 4202. 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:
"Addiction treatment." Treatment provided in or by a
facility licensed by the Department of Drug and Alcohol
Programs.
"Adverse benefit determination." As follows:
(1) A denial, reduction or termination of, or a failure
to provide or make payment in whole or in part for, a
benefit.
(2) The term includes any of the following:
(i) A denial, reduction, termination or failure to
provide or make payment that is based on a determination
of a participant's or beneficiary's eligibility to
participate in a plan.
(ii) With respect to group health plans, a denial,
reduction or termination of, or a failure to provide or
make payment in whole or in part for, a benefit resulting
from the application of any utilization review.
(iii) A failure to cover an item or service for
which benefits are otherwise provided because it is
determined to be experimental or investigational or not
medically necessary or appropriate.
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" Insurer. " As follows:
(1) An entity that issues or administers health
insurance policies or health plans and is subject to the
jurisdiction of the department.
(2) The term includes an entity organized or existing
under, or subject to, any of the following:
(i) The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) The act of May 18, 1976 (P.L.123, No.54),
known as the Individual Accident and Sickness Insurance
Minimum Standards Act.
(iv) Chapter 61 (relating to hospital plan
corporations) or 63 (relating to professional health
services plan corporations).
"MHPAEA." The Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008 (Public Law 110-343, 122
Stat. 3765).
"Review." A utilization review, authorization,
preauthorization, concurrent review, retrospective review or
audit with respect to a benefit and any other process that
results or could result in an adverse benefit determination.
§ 4203. Reporting by insurer.
On or before April 30 of each year, an insurer shall provide
a report containing the following information to the department
for the preceding calendar year:
(1) The total number of the insurer's insureds and plan
members.
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(2) The total number of the insurer's insureds and plan
members who received addiction treatment covered or
authorized by the insurer and by any subcontractor acting on
behalf of the insurer.
(3) For each product line, the units of addiction
treatment authorized by the insurer and its subcontractors,
broken down by treatment setting, including inpatient
hospital detoxification, inpatient hospital rehabilitation,
inpatient nonhospital detoxification, inpatient nonhospital
residential, partial hospitalization and outpatient.
(4) For each product line, the units of addiction
treatment reimbursed or otherwise paid for by the insurer and
its subcontractors, broken down by treatment setting,
including inpatient hospital detoxification, inpatient
hospital rehabilitation, inpatient nonhospital
detoxification, inpatient nonhospital residential, partial
hospitalization and outpatient.
(5) For each product line, the average length of stay or
units of service for each treatment setting, including
inpatient hospital detoxification, inpatient hospital
rehabilitation, inpatient nonhospital detoxification,
inpatient nonhospital resident