HB 2315

                                                 PRINTER'S NO.     3072
                THE GENERAL ASSEMBLY OF PENNSYLVANIA
                    HOUSE BILL
                    No. 2315
                                          Session of
                                            2026
INTRODUCED BY FRIEL, HILL-EVANS, CEPEDA-FREYTIZ, SANCHEZ AND
   D. WILLIAMS, MARCH 24, 2026
REFERRED TO COMMITTEE ON INSURANCE, MARCH 24, 2026
                               AN ACT
1 Amending the act of December 29, 1972 (P.L.1701, No.364),
2    entitled "An act providing for the establishment of nonprofit
3    corporations having the purpose of establishing, maintaining
4    and operating a health service plan; providing for
5    supervision and certain regulations by the Insurance
6    Department and the Department of Health; giving the Insurance
7    Commissioner and the Secretary of Health certain powers and
8    duties; exempting the nonprofit corporations from certain
9    taxes and providing penalties," further providing for rules
10    and regulations.
11    The General Assembly of the Commonwealth of Pennsylvania
12 hereby enacts as follows:
13    Section 1.    Section 14 of the act of December 29, 1972
14 (P.L.1701, No.364), known as the Health Maintenance Organization
15 Act, is amended to read:
16    Section 14.    Rules and Regulations.--(a)   The commissioner
17 and the secretary are authorized and directed to promulgate such
18 reasonable rules and regulations as deemed necessary to
19 effectuate the purposes and provisions of this act.
20    (b)   No later than one year after the effective date of this
21 subsection, the commissioner and the secretary shall promulgate
22 regulations that require a health maintenance organization to
1 not deny payment for basic health services or physicians'
2 services covered under an enrollee's contract solely because the
3 referral was made by a direct primary care provider who is not a
4 participating provider under the health maintenance
5 organization's provider network.
6    (c)   As used in this section, the term "direct primary care
7 provider" means an individual who is a licensed allopathic
8 physician, osteopathic physician or other advanced health care
9 practitioner who is authorized to engage in independent medical
10 practice in this Commonwealth and who provides direct health
11 care by entering into a direct health care service agreement
12 with a patient. The term includes an individual health care
13 provider or a group of health care providers.
14    Section 2.   This act shall take effect in 60 days.
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