HB 1697 amends Pennsylvania's Human Services Code to create a state-level False Claims Act, directly affecting healthcare providers, contractors, and organizations receiving state funds (like Medicaid or welfare programs). It makes individuals or entities liable for three times the damages plus penalties if they knowingly submit false claims, make false records, or conceal obligations to the state. The bill establishes "qui tam" lawsuits allowing whistleblowers to sue on behalf of the state and creates a Fraud Prevention and Recovery Account to hold recovered funds. These provisions align Pennsylvania's law with the federal False Claims Act to combat fraud in public spending.
HB 1234 amends Pennsylvania's Human Services Code to require public assistance programs to cover the cost of blood pressure monitors for eligible recipients. This change directly affects individuals enrolled in state public assistance programs who need blood pressure monitoring for health management. The bill adds blood pressure monitors to the list of covered medical equipment under the public assistance program, ensuring these devices are provided without cost to recipients. It does not change eligibility requirements but expands existing coverage to include this specific monitoring tool. The bill passed final passage on July 1, 2025, and was referred to the Health & Human Services committee.
SB 95 amends Pennsylvania's Pharmacy Act to create a 180-day provisional license for pharmacists moving from other states, allowing them to practice without demonstrating competency under Pennsylvania's requirements. It also permits emergency medical services providers to distribute naloxone dose packages for opioid overdose reversal under specific conditions, including a Department of Health standing order and voluntary distribution without liability. Additionally, the bill requires pharmacies to disclose prescription drug prices (brand vs. generic), cost-sharing amounts, and health insurance options upon customer request. These changes aim to improve pharmacist mobility, expand naloxone access, and increase price transparency for consumers.
HB 1334 allocates funding from the Workmen's Compensation Administration Fund to Pennsylvania's Department of Labor and Industry, Department of Community and Economic Development, and the Office of Small Business Advocate. It covers expenses for administering the Workers' Compensation Act, Pennsylvania Occupational Disease Act, and the Small Business Advocate program for fiscal year 2025-2026, including payments for unpaid bills from the prior fiscal year. The bill directly affects state agencies responsible for worker compensation, occupational disease claims, and small business support services. This is a routine appropriations measure to ensure ongoing operations of these programs, not a policy change. The bill was signed into law as Act No. 3A of 2025 on June 27, 2025.
This bill modifies Pennsylvania's Human Services Code to change how medical providers are reimbursed for specific services provided to public assistance recipients. It updates reimbursement rules for certain medical items and services while replacing outdated regulations that conflicted with these changes. The primary effect is on healthcare providers who bill state assistance programs, streamlining the process for claiming payments. The bill does not create new benefits but adjusts existing reimbursement procedures under public assistance programs.
HB 1445 requires health insurers in Pennsylvania to cover medically necessary health services provided in schools - such as mental health care, behavioral health services, and speech therapy - without denying coverage solely because the service occurs in a school setting. It prohibits insurers from excluding coverage based on location (e.g., through "school setting" or "place of service" exclusions), applying to public, charter, cyber charter, and private schools. Exceptions allow denials if services are provided by unlicensed individuals, are not medically necessary per insurer policies, or conflict with existing legal obligations (like IEPs). This law directly affects students receiving school-based care, insurers, and school entities, ensuring coverage parity for services delivered on school premises.
HB 1088 amends Pennsylvania's 1921 Insurance Company Law to require casualty insurance policies to cover blood pressure monitors. This directly affects policyholders who rely on these devices for managing health conditions like hypertension, ensuring they are not excluded from standard coverage. The bill adds a specific provision mandating insurers to include blood pressure monitors as covered items under casualty insurance policies. It changes insurer obligations without altering broader policy terms, focusing on making a common medical device accessible through existing insurance frameworks.
HB 1140 requires health insurers and Medicaid/CHIP managed care plans in Pennsylvania to cover all FDA-approved contraceptives - including prescription drugs, devices, emergency contraception (like levonorgestrel), and oral contraceptives - without any out-of-pocket costs for enrollees. It specifically prohibits prior authorization or step therapy for emergency and oral contraceptives, and mandates coverage for sterilization procedures and related services like counseling. The bill directly affects health insurers, managed care plans, and their enrollees by expanding contraceptive coverage under state insurance regulations. It exempts male condoms from coverage requirements but ensures no cost-sharing for covered contraceptive methods.
HB 526 protects mothers' right to breastfeed their children in any public or private location where they are otherwise permitted to be, without being considered indecent exposure, a nuisance, or obscenity. It defines "breastfeeding" to include both direct feeding and expressing milk for bottle-feeding, and creates a private right to sue for violations, allowing recovery of $1,000 per incident plus attorney fees. The law applies broadly across Pennsylvania, ensuring mothers can feed their children without legal interference while maintaining existing protections from the repealed 2007 Freedom to Breastfeed Act.
HB 535 bans Pennsylvania health insurers from setting annual or lifetime dollar limits on core health benefits for enrollees, whether services are provided by in-network or out-of-network providers. It applies to all individual and group health insurance policies (excluding specific types like Medicare supplements or dental/vision-only plans) and prohibits limits on benefits that were already covered without such caps in 2025 policies. The Insurance Department can enforce this through fines up to $5,000 per violation (or $10,000 for willful violations), with annual caps of $500,000 for insurers. The law does not require coverage of specific benefits but eliminates existing dollar limit practices for covered services.
