Pennsylvania Act 1981-168 — INSURANCE REIMBURSEMENT - NURSE MIDWIFE SERVICES

Act text

INSURANCE REIMBURSEMENT - NURSE MIDWIFE SERVICES
                 Act of Dec. 23, 1981, P.L. 583, No. 168              Cl. 40
                                  AN ACT

     Providing for reimbursement by insurance companies and others
        for facilities used by or for services performed by licensed
        certified nurse midwives. (Title amended Dec. 20, 1982,
        P.L.1446, No.328)

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

        Section 1.  (a)  This act shall apply to every group or
     individual policy, contract or certificate issued thereunder, of
     health or sickness, or accident insurance delivered or issued
     for delivery within the Commonwealth including but not limited
     to policies, contracts or certificates issued by:
            (1)  Any stock insurance company incorporated for any of
        the purposes set forth in section 202(c), act of May 17, 1921
        (P.L.682, No.284), known as "The Insurance Company Law of
        1921."
            (2)  Any mutual insurance company incorporated for any of
        the purposes set forth in section 202(d) of "The Insurance
        Company Law of 1921."
            (3)  Any professional health services plan corporation as
        defined in 40 Pa.C.S. Ch. 63 (relating to professional health
        services plan corporations).
            (4)  Any fraternal benefit society as defined in 40
        Pa.C.S. Ch. 63.
            (5)  Any health maintenance organization as defined in
        the act of December 29, 1972 (P.L.1701, No.364), known as the
        "Health Maintenance Organization Act."
            (6)  Any person who sells or issues contracts or
        certificates of insurance which meet the requirements of this
        act.
            (7)  Any hospital plan corporation as defined in 40
        Pa.C.S. Ch. 61 (relating to hospital plan corporations).
        (b)  This act shall apply to all such policies, contracts,
     certificates or programs issued, renewed, modified, altered,
     amended or reissued on or after the effective date of this act.
        (c)  This act shall apply to all private and public programs
     for health services and facilities reimbursement, including but
     not limited to any such reimbursement programs operated by the
     Commonwealth.
        (1 amended Dec. 20, 1982, P.L.1446, No.328)
        Section 2.  Whenever an insurance policy, contract or
     certificate or health services reimbursement program provides
     for reimbursement for any health care service which is within
     those areas of practice for which a midwife may be licensed
     pursuant to the act of April 4, 1929 (P.L.160, No.155) or
     pursuant to statute in the state where the service is delivered,
     or for the cost of birthing facilities, the insured or any other
     person covered by the policy, contract or certificate, or health
     services or facilities reimbursement program shall be entitled
     to reimbursement for such service or use of the facilities
     whether the service is performed by a duly licensed physician or
     an osteopath or a duly licensed certified nurse midwife
     practicing within those areas for which the certified nurse
     midwife is licensed in the state where the licensed certified
     nurse midwife is practicing. Whenever such service is performed
     by a licensed certified nurse midwife and reimbursed by a
     professional health services plan corporation, the licensed
     certified nurse midwife shall be granted such rights of
     participation, plan admission and registration as may be granted
     by the professional health services plan corporation, under 40
     Pa.C.S. Ch. 63 (relating to professional health services plan
     corporations) to a physician or osteopath performing such
     service. When payment is made for health care services performed
     by a licensed certified nurse midwife, no payment or
     reimbursement shall be payable to a physician or osteopath for
     the service performed by the licensed certified nurse midwife.
        (2 amended Dec. 20, 1982, P.L.1446, No.328)
        Section 3.  The Insurance Commissioner may promulgate such
     rules and regulations as are deemed necessary for the effective
     implementation and operation of this act.
        Section 4.  This act shall take effect in 60 days.