Pennsylvania Act 2008-108 — INSURANCE (40 PA.C.S.) - SCOPE OF SERVICE AND RIGHTS OF HEALTH SERVICE DOCTORS

Act text

INSURANCE (40 PA.C.S.) - SCOPE OF SERVICE AND RIGHTS OF HEALTH SERVICE
                                 DOCTORS
                 Act of Oct. 9, 2008, P.L. 1393, No. 108              Cl. 40
                             Session of 2008
                               No. 2008-108

     HB 1177

                                  AN ACT

     Amending Title 40 (Insurance) of the Pennsylvania Consolidated
        Statutes, further providing for definitions, for scope of
        service and for rights of health service doctors.

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

        Section 1.  The definitions of "health service doctor" and
     "professional health services" in section 6302(a) of Title 40 of
     the Pennsylvania Consolidated Statutes are amended and the
     subsection is amended by adding definitions to read:
      § 6302.  Definitions.
        (a)  General rule.--The following words and phrases when used
     in this chapter shall have, unless the context clearly indicates
     otherwise, the meanings given to them in this section:
        * * *
        "Clinical social work services."  The general and usual
     services rendered and care administered by licensed clinical
     social workers, as defined by the "practice of clinical social
     work" in the act of July 9, 1987 (P.L.220, No.39), known as the
     Social Workers, Marriage and Family Therapists and Professional
     Counselors Act.
        * * *
        "Health service doctor."  [A] Any health care professional
     duly licensed or certified under Commonwealth statute regulating
     a particular branch of health care practice, including, but not
     limited to, doctor of dental surgery, doctor of medicine, doctor
     of optometry, doctor of osteopathy, doctor of podiatry, doctor
     of chiropractic, licensed physical therapist, licensed clinical
     social worker, licensed occupational therapist, licensed
     marriage and family therapist, licensed professional counselor,
     certified registered nurse anesthetist, certified registered
     nurse practitioner, certified enterostomal therapy nurse,
     certified community health nurse, certified psychiatric mental
     health nurse, certified clinical nurse specialist, licensed
     psychologist, licensed speech-language pathologist, licensed
     audiologist or licensed teacher of persons who are hearing
     impaired.
        * * *
        "Licensed marriage and family therapy services."  The general
     and usual services rendered and care administered by persons
     licensed pursuant to 49 Pa. Code Ch. 48 (relating to State Board
     of Social Workers, Marriage and Family Therapists and
     Professional Counselors-Licensure of Marriage and Family
     Therapists).
        "Licensed professional counseling services."  The general and
     usual services rendered and care administered by persons
     licensed pursuant to 49 Pa. Code Ch. 49 (relating to State Board
     of Social Workers, Marriage and Family Therapists and
     Professional Counselors-Licensure of Professional Counselors).
        * * *
        "Occupational therapy services."  The general and usual
     services rendered and care administered by licensed occupational
     therapists, as defined by "occupational therapy" in the act of
     June 15, 1982 (P.L.502, No.140), known as the Occupational
     Therapy Practice Act.
        * * *
        "Professional health services."  [Dental services, medical
     services, optometric services, osteopathic services, podiatry
     services, chiropractic services, physical therapy services,
     psychological services, speech-language pathology services,
     audiology services, services of teachers of persons who are
     hearing impaired, certified registered nurse services provided
     by a certified registered nurse at any time except when the
     certified registered nurse is acting as an employee of a health
     care facility or of an anesthesiology group or any one or more
     of them, provided any of the above-listed services are medically
     necessary.] Professional services provided by a duly licensed
     health service doctor, provided that the services are medically
     necessary.
        * * *
        Section 2.  Sections 6322(f) and 6324(a) of Title 40 are
     amended to read:
      § 6322.  Scope of service.
        * * *
        (f)  Legislative amendment of stated purposes of existing
     corporations.--The stated purposes of all existing general
     medical service corporations are hereby amended so as to include
     the furnishing of osteopathic, dental, optometric, podiatry,
     chiropractic, physical therapy, clinical social work,
     occupational therapy, psychological, speech-language pathology
     and audiology services and the services of teachers of persons
     who are hearing impaired through doctors of osteopathy,
     dentistry, optometry, podiatry and chiropractic and through
     licensed physical therapists, licensed clinical social workers,
     licensed marriage and family therapists, licensed occupational
     therapists, licensed professional counselors, psychologists,
     speech-language pathologists, audiologists and teachers of
     persons who are hearing impaired, respectively.
      § 6324.  Rights of health service doctors.
        (a)  Admission to plan.--Every health service doctor
     practicing within the area covered by any professional health
     service corporation shall have the right, on complying with such
     regulations as the corporation may make with the approval of the
     Department of Health, to register with such corporation for such
     general or special professional health services as he may be
     licensed to practice, within that area, but the corporation may,
     with the approval of the Department of Health, refuse to place
     the name of any health service doctor on its register. Any
     professional health service corporation may, with the approval
     of the Department of Health, remove from its register the name
     of any health service doctor after due notice and opportunity
     for hearing for cause satisfactory to the corporation. Nothing
     in this section shall be construed to limit the discretion of a
     professional health service corporation to determine the classes
     or kinds of services that will be covered under its contracts.
        * * *
        Section 3.  This act shall take effect in 120 days.

     APPROVED--The 9th day of October, A. D. 2008.

     EDWARD G. RENDELL