35 Pa. Stat. and Cons. Stat. Ann. §§ 449.31 through 449.36: Health Care Practitioners Medicare Fee Control Act – Pennsylvania
Status: Enacted Year Enacted: 1990
The General Assembly declares its policy to be that, in accordance with the provisions of this act, providers of health care services should not charge or collect from a beneficiary of health insurance under Medicare …
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35 Pa. Stat. and Cons. Stat. Ann. §§ 449.91 through 449.97: Preventable Serious Adverse Events Act – Pennsylvania
Status: Enacted Year Enacted: 2009
States that a health care provider may not knowingly seek payment from a health payor or patient:(1) for a preventable serious adverse event; or (2) for any services required to correct or treat the problem …
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35 Pa. Stat. and Cons. Stat. Ann. §§ 5701.1101 through 5701.1108: Tobacco Settlement Act — Hospital Uncompensated Care – Pennsylvania
Status: Enacted Year Enacted: 2001
There is established in the department the Hospital Uncompensated Care Program. Appropriations from the fund to the department for the Hospital Uncompensated Care Program pursuant to section 1106(b) shall be used to annually compensate hospitals …
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35 Pa. Stat. and Cons. Stat. Ann. §§ 5701.1301 through 5701.1304. Tobacco Settlment Act — Health Investment Insurance – Pennsylvania
Status: Enacted Year Enacted: 2001
There is established in the department an adult basic coverage insurance program. Fund appropriations to the department for the program shall be used for contracts to provide basic health care insurance for eligible adults and …
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40 Pa. Cons. Stat. § 1560. Supervision: Health Maintenance Organization – Pennsylvania
Status: Enacted Year Enacted: 1972
Applies to HMOs; All premium rates charged must be approved by and be on file with the Commissioner of Insurance.
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40 Pa. Cons. Stat. § 1561. Reports and examinations: Health Maintenance Organizations – Pennsylvania
Status: Enacted Year Enacted: 1972
Requires health maintenance organizations to file with the commissioner a statement summarizing its financial activities, which will be examined by the commissioner.
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40 Pa. Cons. Stat. § 764a. Preferred provider organizations: Health and Accident Insurance – Pennsylvania
Status: Enacted Year Enacted: 1986
Describes the role of preferred provider organizations, what happens in their assumption of risk and the role of the Insurance Commissioner.
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40 Pa. Cons. Stat. § 991.2112. Financial incentives prohibition: Managed Care Plan Requirements – Pennsylvania
Status: Enacted Year Enacted: 1998
No managed care plan shall use any financial incentive that compensates a health care provider for providing less than medically necessary and appropriate care to an enrollee. Nothing in this section shall be deemed to …
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40 Pa. Cons. Stat. § 991.2151. Certification: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
A utilization review entity may not review health care services delivered or proposed to be delivered in this Commonwealth unless the entity is certified by the department to perform utilization review.
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40 Pa. Cons. Stat. § 991.2152. Operations standards: Utilization Review – Pennsylvania
Status: Enacted Year Enacted: 1998
Outlines requirements for an entity to perform utilization review.
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40 Pa. Cons. Stat. § 991.2162. External grievance process: Quality Health Care Accountability and Protection – Pennsylvania
Status: Enacted Year Enacted: 1998
A managed care plan shall establish and maintain an external grievance process by which an enrollee or a health care provider with the written consent of the enrollee may appeal the denial of a grievance …
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40 Pa. Cons. Stat. §§ 3801 through 3806: Retroactive Denial of Reimbursements – Pennsylvania
Status: Enacted Year Enacted: 2016
An insurer that retroactively denies reimbursement to a health care provider under this chapter shall do so based upon coding guidelines and policies in effect at the time the service subject to the retroactive denial …
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40 Pa. Stat. and Cons. Stat. Ann. § 756.2. Group accident and sickness insurance: Health and Accident Insurance – Pennsylvania
Status: Enacted Year Enacted: 1955
Governs the issuance of group accident and sickness insurance.
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40 Pa. Stat. and Cons. Stat. Ann. § 756.3. Blanket accident and sickness insurance: Health and Accident Insurance – Pennsylvania
Status: Enacted Year Enacted: 1955
Governs the issuance of blanket accident and sickness insurance.
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40 Pa. Stat. and Cons. Stat. Ann. § 764a. Preferred provider organizations: Health and Accident Insurance – Pennsylvania
Status: Enacted Year Enacted: 1986
Governs preferred provider organizations and the powers of the insurance commissioner.
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40 Pa. Stat. and Cons. Stat. Ann. § 991.1201. Definitions: Uniform Health Insurance Claim Form – Pennsylvania
Status: Enacted Year Enacted: 1992
Provides definitions for uniform health insurance claim form.
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