Pennsylvania HB 2212: An Act amending the act of April 12, 1951 (P.L.90, No.21), known as the Liquor Code, in licenses and regulations and liquor, alcohol and malt and brewed beverages, further providing for unlawful acts relative to liquor, malt and brewed beverages and licensees.

Bill Text

PRINTER'S NO. 2906
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2212
Session of
2026
INTRODUCED BY MALAGARI, GIRAL, HILL-EVANS, FREEMAN, SANCHEZ,
McANDREW, MAYES, D. WILLIAMS, HADDOCK, CEPEDA-FREYTIZ,
CIRESI, GALLAGHER AND MADDEN, FEBRUARY 10, 2026
REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 11, 2026
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for nondiscrimination by payers in
health care benefit plans.
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 46
NONDISCRIMINATION BY PAYERS
IN HEALTH CARE BENEFIT PLANS
Sec.
4601. Definitions.
4602. Discrimination against willing facility prohibited.
4603. Applicability.
4604. Retaliation prohibited.
§ 4601. Definitions.
The following words and phrases when used in this chapter
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shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Ambulatory surgical facility." The term shall have the same
meaning as defined under section 802.1 of the act of July 19,
1979 (P.L.130, No.48), known as the Health Care Facilities Act.
"Arbitrator." An independent and impartial third party
accredited by a national or international organization that
specializes in dispute management with subject matter expertise
in health care.
"Baseball-style arbitration." A method by which an
arbitrator selects either the figure submitted by the health
care benefit plan or the figure submitted by the out-of-network
facility.
"CPT." The Current Procedural Terminology 2024 code set as
published by the American Medical Association.
"DRG." The Diagnosis Related Group classification system
that uses patient discharge information to classify patients
into clinically meaningful groups.
"Facility." A physician-owned hospital or physician-owned
ambulatory surgical facility.
"Health care benefit plan." An insurance policy, contract or
plan that provides health care to participants or beneficiaries
directly or through insurance, reimbursement or otherwise.
"Health care payer." An individual or entity that is
responsible for providing or paying for all or part of the cost
of health care services covered by a health care benefit plan.
The term includes an entity subject to at least one of the
following:
(1) Chapter 61 (relating to hospital plan corporations)
or 63 (relating to professional health services plan
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corporations).
(2) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including either of the
following:
(i) A preferred provider organization subject to
section 630 of The Insurance Company Law of 1921.
(ii) A fraternal benefit society subject to Article
XXIV of The Insurance Company Law of 1921.
(3) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(4) An agreement by a self-insured employer or self-
insured multiple employer trust to provide health care
benefits to employees and the employees' dependents.
"Highest in-network rate." The highest rate for a service or
fee that is determined by identifying the contracted rates of
all plans of a health care payer or administering entity, if
applicable, or all coverage offered by the health care payer in
the same individual marketplace rating area as defined by the
department for the same or similar item or service that is
provided by a facility in the same or similar specialty or
facility type and provided in the geographic region in which the
item or service is furnished.
"Hospital." The term shall have the same meaning as defined
under section 802.1 of the Health Care Facilities Act.
"Out-of-network facility." A facility that has not
contracted with a health care payer to provide health care
services to insureds covered by a health care payer.
§ 4602. Discrimination against willing facility prohibited.
(a) Prohibition.--A health care payer shall reimburse a
facility willing to provide health care services. A health care
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payer shall not discriminate against a facility delivering
health care services who:
(1) Agrees to accept either the health care payer's
highest in-network rate or a baseball-style arbitration and
obtains and maintains Center for Medicare and Medicaid
Services accreditation status.
(2) Can perform the procedure at an earlier date than
the nearest in-network facility.
(3) Meets at least one of the following quality metrics:
(i) A hospital facility achieves a Hospital Consumer
Assessment of Healthcare Providers and Systems, or
successor rating system, patient satisfaction survey
rating of at least four stars.
(ii