Pennsylvania SB 318: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for postacute neurorehabilitation.

Bill Text

PRINTER'S NO. 252
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 318
Session of
2025
INTRODUCED BY KEARNEY, J. WARD, HUGHES, FONTANA, BROWN, HAYWOOD,
TARTAGLIONE, COSTA, FARRY, LAUGHLIN AND KANE,
FEBRUARY 26, 2025
REFERRED TO BANKING AND INSURANCE, FEBRUARY 26, 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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

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 employe
welfare benefit plan as defined in section 3 of the Employee
Retirement Income Security Act of 1974 (Public Law 93-406, 29
U.S.C. § 1001 et seq.) 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 set out in the Office of Long-Term Living's Home and
20250SB0318PN0252 - 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

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.
20250SB0318PN0252 - 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

(7) Medicare supplement.
(8) Civilian Health and Medical Prog