Pennsylvania Act 1986-209 — INSURANCE PAYMENT TO REGISTERED NURSE LAW

Act text

INSURANCE PAYMENT TO REGISTERED NURSE LAW
                 Act of Dec. 19, 1986, P.L. 1737, No. 209             Cl. 40
                                  AN ACT

     Providing for reimbursement by insurance companies, professional
        health service plan corporations, fraternal benefit societies
        and voluntary nonprofit health service plans for service
        performed by a registered nurse; and providing further duties
        of the Insurance Department.

        The General Assembly of the Commonwealth of Pennsylvania
     hereby enacts as follows:

     Section 1.  Short title.
        This act shall be known and may be cited as the Insurance
     Payment to Registered Nurse Law.
     Section 2.  Definitions.
        The following words and phrases when used in this act shall
     have the meanings given to them in this section unless the
     context clearly indicates otherwise:
        "Department."  The Insurance Department of the Commonwealth.
     Section 3.  Policies and contracts covered.
        (a)  Coverage enumerated.--This act shall apply to every
     group policy, contract or certificate issued thereunder, of
     health, sickness or accident insurance delivered or issued for
     delivery within the Commonwealth, including, but not limited to,
     policies, contracts or certificates issued by:
            (1)  Any stock insurance company as described in section
        202(c)(4) and (11) and any mutual insurance company as
        described in section 202(d)(1) of the act of May 17, 1921
        (P.L.682, No.284), known as The Insurance Company Law of
        1921.
            (2)  Any hospital plan corporation as defined in 40
        Pa.C.S. Ch. 61 (relating to hospital plan corporations).
            (3)  Any professional health services plan corporation as
        defined in 40 Pa.C.S. Ch. 63 (relating to professional health
        services plan corporations).
            (4)  Any fraternal benefit society as defined in 40
        Pa.C.S. Ch. 65 (relating to fraternal benefit societies).
            (5)  Any voluntary nonprofit health service plan as
        defined in the act of December 29, 1972 (P.L.1701, No.364),
        known as the Health Maintenance Organization Act.
            (6)  Any person who sells or issues contracts or
        certificates of insurance which meet the requirements of this
        act.
        (b)  Application of act.--This act shall apply to policies,
     contracts or certificates issued, renewed, modified, altered,
     amended or reissued on and after the effective date of this act.
     Section 4.  Scope of coverage.
        (a)  General rule.--When a service is performed by a
     certified registered nurse anesthetist, certified registered
     nurse practitioner, certified enterostomal therapy nurse,
     certified community health nurse, certified psychiatric mental
     health nurse or certified clinical nurse specialist, certified
     by the State Board of Nursing or a national nursing organization
     recognized by the State Board of Nursing and lawfully permitted
     to perform that service under the act of May 22, 1951 (P.L.317,
     No.69), known as The Professional Nursing Law, and a policy,
     contract or certificate provides for reimbursement for that
     service, the insured or any other person covered shall be
     entitled to reimbursement either to the insured or to the
     registered professional nurse providing that service. This
     section does not apply to registered professional nurses who are
     employees of health care facilities as the term "health care
     facilities" is defined in the act of July 19, 1979 (P.L.130,
     No.48), known as the Health Care Facilities Act, or
     anesthesiology groups.
        (b)  Application of reimbursement process.--Nothing in this
     section shall apply to the assignment of benefits and payment of
     claims process of a stock insurance company and a mutual
     insurance company as set forth in section 3(a)(1).
        (c)  Nonduplication of payments.--Duplicate payments shall
     not be made to either:
            (1)  both a nurse provider as set forth in subsection (a)
        and another provider; or
            (2)  to the same provider
     for the same services provided in a single encounter.
     Section 5.  Rules and regulations.
        The department shall, in the manner provided by law,
     promulgate the rules, regulations and forms necessary to carry
     out this act. Following publication of the initial set of
     proposed regulations in the Pennsylvania Bulletin, but prior to
     their formal adoption, the department shall hold public hearings
     thereon.
     Section 6.  Construction of act.
        Nothing in this act shall be deemed to affect or impair the
     act of May 22, 1951 (P.L.317, No.69), known as The Professional
     Nursing Law, nor to confer upon any public or private
     organization or agency the power to interpret or enforce this
     act, except as may be provided for therein.
     Section 7.  Effective date.
        This act shall take effect in 90 days.