§ 1416. Parity in insurance coverage for State-owned psychiatric hospitals
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 62 P.S. Poor Persons and Public WelfareEffective: July 7, 2005
Effective: July 7, 2005
62 P.S. § 1416
§ 1416. Parity in insurance coverage for State-owned psychiatric hospitals
(a) No insurer providing inpatient psychiatric care coverage to individuals covered by that insurer's plan shall deny payment to a State-owned psychiatric hospital for medically necessary services provided to that individual solely on the basis that the hospital is a government-owned facility, has no signed provider agreement with the insurer or does not participate in the insurer's network.
(b) The provision of psychiatric services at a State-owned psychiatric hospital shall be an assignment by operation of law to the hospital of the individual's right to recover for such services from that individual's insurer. The department may sue for and recover any amounts due from that individual's insurer.
(d) State-owned psychiatric hospitals may enter into provider agreements with insurers and may accept payments under such provider agreements as payment in full, excluding the patient's liability for unpaid deductible and coinsurance amounts. In the absence of a provider agreement, the insurer shall make payment for a hospital stay at its usual rate of payment to contracted psychiatric hospital providers or, in the absence of such a rate, the rate that the medical assistance program would pay for such care.
(1) A stock insurance company incorporated for any of the purposes set forth in section 202(c) of the act of May 17, 1921 (P.L. 682, No. 284),1 known as “The Insurance Company Law of 1921.”
(5) A fraternal benefit society as defined in 40 Pa.C.S. Ch. 63.2
(6) A health maintenance organization as defined in the act of December 29, 1972 (P.L. 1701, No. 364),3 known as the “Health Maintenance Organization Act.”
Credits
1967, June 13, P.L. 31, No. 21, art. 14, § 1416, added 2005, July 7, P.L. 177, No. 42, § 9, imd. effective.
Footnotes
40 P.S. § 382.
So in original. Probably should read “40 Pa.C.S. Ch. 65” (repealed); see now, 40 P.S. § 991.2401 et seq.
40 P.S. § 1551 et seq.
62 P.S. § 1416, PA ST 62 P.S. § 1416
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
End of Document |