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 It updates reimbursement rules for certain medical items and services while replacing outdated regulations that conflicted with these changes.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 282 amends Pennsylvania's Human Services Code (1967) to clarify eligibility rules for individuals receiving medical assistance under public assistance programs. The bill directly affects current and prospective recipients of medical assistance, ensuring consistent application of qualification standards. Key provisions update how eligibility is determined for medical assistance, though specific changes are not detailed in the provided context. The bill passed the House on June 3, 2025, and was referred to the Health & Human Services committee for further review.
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 79 requires hospitals to establish clear financial assistance programs for patients who cannot afford care, including standardized forms and easily accessible information about eligibility and coverage. It mandates that hospitals publicly share details about their financial aid policies and report their program rules to the Department of Health. These requirements directly affect hospitals operating in the state and patients seeking financial help with medical bills. The bill aims to standardize and increase transparency in hospital financial aid offerings.
HB 269 amends Pennsylvania's Controlled Substance Act to improve access to overdose response information. It requires the Department of Health to develop free online training materials, posters, and pamphlets about recognizing opioid overdoses and using reversal medications (like naloxone), with the materials available in multiple languages upon request. Specific public entities - including Commonwealth agencies, transit authorities, municipalities, and local transportation organizations - must display the poster in conspicuous public locations, such as bathrooms or lobbies. The Department covers all printing and distribution costs, and entities already displaying equivalent materials may substitute them with prior notice. This bill focuses on education and resource accessibility, not changing drug laws or medication access.
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.
HB 618, the Health Insurance Access Protection Act, prohibits health insurers from denying coverage or charging higher premiums based on a person's health condition, including preexisting conditions. This law applies to both individual and group health insurance policies, protecting enrollees and their dependents from discrimination in enrollment or pricing. The Insurance Department and Commissioner are tasked with enforcing these rules, and the bill includes penalties for insurers that violate the prohibitions.
HB 755 requires health insurers in Pennsylvania (excluding grandfathered plans) to cover all preventive health services listed by the Insurance Department without cost-sharing, such as copays or deductibles. This directly affects insurers who must comply with the coverage rules and enrollees who gain access to preventive care like vaccinations and screenings at no extra cost. The bill empowers the Insurance Department to create and update the preventive services list through a public comment process (15+ business days) and enforce compliance with penalties for violations. It aligns with federal preventive care standards but allows Pennsylvania to adjust the list based on public input and evidence-based guidelines.
