Pennsylvania HB 444: An Act providing for limitation on damages in actions against entities for children.

Bill Text

PRINTER'S NO. 422
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 444
Session of
2025
INTRODUCED BY BRIGGS, FEE, FLOOD, McNEILL, SANCHEZ, PROBST,
SCHLOSSBERG, KHAN, PIELLI, GUENST, HILL-EVANS, NEILSON,
CIRESI, FREEMAN, FLEMING, OTTEN, STEELE, CERRATO AND
E. NELSON, FEBRUARY 3, 2025
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 3, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for postacute neurorehabilitation.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Coverage for Postacute
Neurorehabilitation.--(a) All group or individual health or
sickness or accident insurance policies providing hospital or
medical/surgical coverage and all group or individual subscriber
contracts or certificates issued by any entity subject to 40
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Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63
(relating to professional health services plan corporations),
this act, the act of December 29, 1972 (P.L.1701, No.364), known
as the Health Maintenance Organization Act, or an "employee
welfare benefit plan" as the term is defined in section 3 of 29
U.S.C. Ch. 18 (relating to Employee Retirement Income Security
Program) providing hospital or medical/surgical coverage shall
also provide coverage for postacute neurorehabilitation for an
acquired brain injury. Coverage under this section shall include
medically necessary treatment related to or as a result of an
acquired brain injury, including cognitive communication
therapy, cognitive rehabilitation therapy, neurobehavioral
therapy, neurophysiological testing and treatment,
neuropsychological testing and treatment, functional
rehabilitation therapy, community reintegration services,
postacute transitional rehabilitation treatment and day
rehabilitation treatment and provide for such services as needed
in facility and home and community-based settings.
(b) Prior to payment for postacute neurorehabilitation
services, an insurer shall verify that the neurorehabilitation
individual practitioners and treatment facilities provide
services within the scope of the services provided under a
Commission on Accreditation of Rehabilitation Facilities
accredited rehabilitation program for brain injury or another
nationally recognized accredited rehabilitation program for
brain injury and are qualified to provide postacute care
rehabilitation services through possession of the appropriate
licenses, accreditation, training and experience deemed
customary and routine in the trade practice and according to
criteria specified in the Office of Long-Term Living's Home and
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Community-Based Community HealthChoices Waiver.
(c) Coverage under this section may not limit the number of
days of covered postacute care, including any therapy or
treatment or rehabilitation, testing, remediation or other
service described under this section, or the number of days of
covered inpatient care to the extent that the treatment or care
is determined to be medically necessary as a result of and
related to an acquired brain injury. The insured's or enrollee's
treating physician shall determine whether treatment or care is
medically necessary for purposes of this paragraph in
consultation with the treatment or care provider, the insured or
enrollee and, if appropriate, members of the insured's or
enrollee's family. Any limitations shall be separately stated by
the Insurance Department.
(d) Coverage under this section shall not be subject to any
greater deductible, coinsurance, copayments or out-of-pocket
limits than any other benefit provided by the Insurance
Department.
(e) The Insurance Department shall promulgate rules and
regulations that require an insurer to provide adequate training
to personnel responsible for preauthorization of coverage or
utilization review for services under this section.
(f) This section shall not apply to the following types of
policies:
(1) Accident only.
(2) Limited benefit.
(3) Credit.
(4) Dental.
(5) Vision.
(6) Specified disease.
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