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
Amending the act of December 29, 1972 (P.L.1701, No.364),
entitled "An act providing for the establishment of nonprofit
corporations having the purpose of establishing, maintaining
and operating a health service plan; providing for
supervision and certain regulations by the Insurance
Department and the Department of Health; giving the Insurance
Commissioner and the Secretary of Health certain powers and
duties; exempting the nonprofit corporations from certain
taxes and providing penalties," further providing for rules
and regulations.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 14 of the act of December 29, 1972
(P.L.1701, No.364), known as the Health Maintenance Organization
Act, is amended to read:
Section 14. Rules and Regulations.--(a) The commissioner
and the secretary are authorized and directed to promulgate such
reasonable rules and regulations as deemed necessary to
effectuate the purposes and provisions of this act.
(b) No later than one year after the effective date of this
subsection, the commissioner and the secretary shall promulgate
regulations that require a health maintenance organization to
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not deny payment for basic health services or physicians'
services covered under an enrollee's contract solely because the
referral was made by a direct primary care provider who is not a
participating provider under the health maintenance
organization's provider network.
(c) As used in this section, the term "direct primary care
provider" means an individual who is a licensed allopathic
physician, osteopathic physician or other advanced health care
practitioner who is authorized to engage in independent medical
practice in this Commonwealth and who provides direct health
care by entering into a direct health care service agreement
with a patient. The term includes an individual health care
provider or a group of health care providers.
Section 2. This act shall take effect in 60 days.
20260HB2315PN3072 - 2 -
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