This bill requires health insurance policies and government programs in Pennsylvania to cover behavioral health services for children involved in the juvenile justice system. It mandates that insurers provide funding for screenings, assessments, and treatments related to mental health conditions and substance use disorders during specific legal proceedings, such as mandatory intake conferences and informal adjustments. The legislation also establishes clear definitions for terms like "behavioral health provider" and "screening" to ensure consistent application of these coverage requirements. By integrating mental health support into the juvenile justice process, the bill aims to address the needs of youth facing delinquency charges while maintaining a neutral focus on policy implementation.
This bill, known as the Patient Right-to-Understand Act, requires health care entities in Pennsylvania to provide patients with clear, plain-language summaries of their insurance coverage, prior authorization rules, and appeal rights. These summaries must be written at a sixth-grade reading level, limited to two pages, and include details on costs, network restrictions, and payment options like cash pricing or health savings accounts. The law also mandates that providers clearly distinguish between what insurance covers and medical decisions made solely between a patient and their doctor. As an enforcement measure, health care entities that fail to comply with these disclosure requirements are prohibited from collecting debts from patients who dispute the care they received.
This bill amends Pennsylvania's Public Official Compensation Law to establish health insurance benefits for members of the House of Representatives. The legislation defines these benefits to include medical, dental, vision, prescription drug, and long-term care coverage, which the state will pay for on behalf of the representative and their eligible dependents. Coverage is limited to the time a member serves in office and includes a specific period between legislative sessions if the representative is reelected. The changes apply only to House members elected after the law takes effect, which is set for 60 days from its passage.
SB 1211 amends Pennsylvania's Insurance Company Law of 1921 to require casualty insurance policies to cover biomarker testing for medical assistance and Children's Health Insurance Program enrollees. The bill defines medical assistance and CHIP managed care plans as health care plans that use gatekeepers to manage services, explicitly including biomarker testing in this definition. This change ensures that insurance coverage for these specific health services is standardized under state law, subject to necessary federal approval. The legislation takes effect 60 days after passage.
This Pennsylvania bill requires health insurance companies to collect and report detailed statistics on addiction treatment services provided under their plans. Insurers must submit annual reports to the state department by April 30, including data on the number of people receiving treatment, units of service authorized and paid for, average length of stay, and the percentage of treatment requests that were denied or limited. The reported information is broken down by treatment type, such as inpatient rehabilitation, outpatient services, and detoxification, while protecting individual patient privacy. The state Department of Drug and Alcohol Programs will review these reports to check compliance with federal parity laws and Pennsylvania regulations, then share findings with legislative committees.
This bill requires health insurance companies in Pennsylvania to annually certify that their mental health and addiction treatment coverage complies with federal and state parity laws. Insurers must submit sworn statements by January 1 each year confirming they have reviewed all their policies and plans for compliance, including those managed by third-party administrators. The law also clarifies which types of insurance policies are covered and establishes specific filing deadlines with the state insurance department. These changes aim to ensure consistent oversight of mental health and substance use disorder benefits across the state's health insurance market.
This bill requires health insurance companies in Pennsylvania to send their policyholders a clear, two-page notice twice each year explaining what addiction treatment services are covered under their plans. The notice must detail specific care levels like detoxification and rehabilitation, explain how long stays are available, describe how to access services, and outline appeal processes. Insurers must submit these notices to the Department of Drug and Alcohol Programs for review before sending them to customers, and the department has 45 days to approve or request changes. Companies that fail to provide this information as required could face administrative fines or penalties determined by the department.
SB 1195 requires most health insurance plans in Pennsylvania to cover preventive services listed by the Insurance Department without cost-sharing (like copays or deductibles). It directly affects health insurers and enrollees (people with health insurance), excluding grandfathered plans (existing before 2010) and limited policies like dental-only or vision-only coverage. The bill establishes a "preventive services list" maintained by the Insurance Department, which can add or remove services after a public comment period. Insurers must cover all listed services without out-of-pocket costs for enrollees, with the department enforcing compliance and imposing penalties for violations.
HB 2212 requires Pennsylvania health insurance companies and other health care payers (including health maintenance organizations and self-insured employers) to reimburse out-of-network medical facilities that meet specific criteria, such as having a four-star patient satisfaction rating, offering faster service than nearby in-network facilities, or being partially owned by physicians who are in-network with the payer. The bill mandates that payers use a "baseball-style arbitration" process for payment disputes, where an independent third party selects either the payer's or facility's proposed payment amount without modification. It defines key terms like "highest in-network rate" to standardize how payers determine fair reimbursement for services. This law directly affects health care benefit plans regulated under Pennsylvania insurance law, aiming to reduce discrimination against qualifying out-of-network providers.
SB 1126 requires most health insurance plans in Pennsylvania to cover at least two epinephrine delivery systems (such as EpiPens for severe allergic reactions) per year at a maximum annual cost of $35, regardless of the insured's deductible or other cost-sharing. This applies to individual and group health insurance policies, as well as certain nonprofit health plans. The Attorney General must investigate epinephrine drug pricing and submit a public report to the legislature within one year. The bill also allows plans to reduce cost-sharing below $35 and applies to high deductible and catastrophic health plans where permitted by federal law.
