HB 2315 — An Act amending the act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act, further providing for rules and regulations.

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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