Healthcare (Medicaid)

passed · Pennsylvania · House Jul 23, 2025

HB 1697: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, providing for liability for false claims, for adoption of congressional intent of the Federal False Claims Act, for damages, costs and civil penalties, for powers of Attorney General, for qui tam actions and for civil investigative demands; and establishing the Fraud Prevention and Recovery Account.

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.

Topics ✓ HealthcareSupports HealthcarePrevents fraud in state healthcare programs (e.g., Medicaid) by imposing penalties on false claims, protecting public funds used for healthcare services.85% confidence

Sub-Topics Medicaid Substance Abuse

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passed · Pennsylvania · House Jun 3, 2025

HB 282: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for persons eligible for medical assistance.

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.

Topics ✓ HealthcareSupports HealthcareClarifies medical assistance eligibility rules to ensure consistent access, directly strengthening healthcare coverage for public assistance recipients.90% confidence

Sub-Topics Medicaid

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in committee · Pennsylvania · House Mar 31, 2025

HB 1068: An Act providing for licensure of family members to provide skilled care to designated children, for applications for licensure, for qualifications for licensure, for employment and compensation of licensed family members, for limitations and supervision of licensed family members, for notice to parents of recipients and for authorization of covered skilled care.

HB 1068 creates a licensing program allowing family members (such as parents, grandparents, or adult siblings) to provide Medicaid-covered skilled care to children with medical needs. To qualify, applicants must complete training, pass background checks, and meet state nursing standards. The bill requires Medicaid agencies to cover the cost of training and licensure renewal, and it mandates that licensed family caregivers receive compensation for services like skilled monitoring. This directly affects Medicaid recipients (children under 21 with diagnosed conditions) and their eligible family caregivers, with oversight by the State Board of Nursing.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid-covered skilled care access by licensing family caregivers, requiring Medicaid to fund training/licensure, and mandating compensation for services.95% confidence

Sub-Topics Medicaid Medical Licensing

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in committee · Pennsylvania · House Jul 14, 2025

HB 1721: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for medical assistance coverage for peer recovery support services.

HB 1721 adds medical assistance coverage under public assistance programs for peer recovery support services. This means individuals receiving state-funded public assistance (like Medicaid) would now have access to coverage for services provided by trained peers who have lived experience with recovery. The bill directly affects people seeking substance use disorder treatment through public assistance programs. It amends the Human Services Code to require coverage for these specific peer services, expanding available treatment options without changing existing eligibility rules. The bill is currently in the Human Services committee for review.

Topics ✓ HealthcareSupports HealthcareAdds Medicaid coverage for peer recovery services in substance use treatment, expanding access to mental health support under public assistance programs.95% confidence

Sub-Topics Medicaid Substance Abuse

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in committee · Pennsylvania · House May 5, 2025

HB 1391: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for reimbursement for custom-fabricated devices, custom-fitted devices, orthosis, orthotics, over-the-counter prostheses, orthoses and pedorthic devices, prefabricated orthoses, prostheses, prosthetics and components of such devices.

House Bill 1391 amends The Insurance Company Law of 1921 to mandate that individual and group health insurance policies provide coverage for various custom-fabricated, custom-fitted, orthotic, prosthetic, and pedorthic devices. This applies when these devices are prescribed by an authorized medical professional, directly affecting individuals who require such medical aids and the health insurance companies providing their coverage. The bill requires coverage for the fitting, repair, or replacement of these devices, including those used for recreational, organized, or adaptive sports, and allows insurers to require preauthorization while applying standard cost-sharing. Additionally, Medicaid and contracted insurers would reimburse for these devices at Federal Medicare rates.

Topics ✓ HealthcareSupports HealthcareMandates health insurance coverage for prescribed medical devices, expanding patient access to essential orthotics/prosthetics under healthcare policy.95% confidence

Sub-Topics Insurance Medicaid Medicare

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passed · Pennsylvania · Senate Jun 26, 2026

SB 482: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for definitions, for administration of assistance programs and for regulations for protection of information; in the aged, further providing for Life Program; and making a repeal.

SB 482 amends Pennsylvania's Human Services Code to improve access to home-based and community-based services for older adults. It directly affects older Pennsylvanians seeking long-term care, LIFE program organizations, and older adult daily living centers by requiring the state department to share eligibility information with these providers and clarifying rules for Medicaid managed care enrollment. Key mechanisms include mandating that applicants receive information about LIFE programs and daily living centers after eligibility assessments, preventing Medicaid managed care assignments until after such assessments, and requiring quarterly enrollment reports by county. The bill also adds definitions for "LIFE program" and "older adult daily living center" to streamline service coordination. These changes aim to enhance transparency and access to care options without altering benefit levels or funding.

Topics ✓ HealthcareSupports HealthcareBill improves access to home/community-based long-term care for seniors by mandating eligibility info sharing, clarifying Medicaid enrollment, and requiring LIFE program info for applicants.95% confidence

Sub-Topics Long-Term Care Medicaid

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in committee · Pennsylvania · House Mar 6, 2025

HB 821: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in departmental powers and duties as to licensing, further providing for regulations.

HB 821 amends Pennsylvania's Human Services Code to require the Department of Human Services to add assisted living services and supplemental health care services to the Community HealthChoices Medicaid program within 60 days. This change directly affects licensed assisted living residences, allowing them to become certified as medical assistance providers for these services. The bill mandates that the department submit necessary documentation to the federal Centers for Medicare and Medicaid Services (CMS) to implement the expansion. The policy change will enable these facilities to participate in the state's Medicaid program for covered services. The bill takes effect 60 days after enactment.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid coverage by adding assisted living and supplemental health services to Community HealthChoices, increasing provider access and patient coverage under state Medicaid program.92% confidence

Sub-Topics Long-Term Care Medicaid Medicare

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in committee · Pennsylvania · Senate Jan 22, 2025

SB 58: An Act establishing the Medicaid Care Transition Program; and imposing duties on the Department of Human Services.

SB 58 establishes the Medicaid Care Transition Program to address delays in moving Medicaid patients from emergency departments to appropriate post-acute care settings. It directly affects Medicaid enrollees stuck in emergency departments, hospitals, and county Medicaid managed care plans (as "responsible entities"). Key provisions require responsible entities to create care transition units that work with hospitals to secure placements within 24 hours (or seek out-of-network options if needed), and notify the Department of Human Services if placement fails after 48 hours. The Department must then convene teams to resolve barriers, collect data, and submit annual reports to legislative committees on program effectiveness.

Topics ✓ HealthcareSupports HealthcareEstablishes Medicaid Care Transition Program to reduce ER wait times for post-acute care, improving patient access and system efficiency.95% confidence

Sub-Topics Hospitals Medicaid

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in committee · Pennsylvania · House Jun 24, 2026

HB 1244: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for pelvic floor therapy.

HB 1244 requires health insurance policies and government health programs in Pennsylvania to cover pelvic floor therapy and related treatments for pelvic floor dysfunction. This includes services like biofeedback, trigger point therapy, electrical stimulation, and postoperative care for prostatectomies, hysterectomies, and postpartum assessments. The coverage applies to policies issued or renewed after the bill's effective date, though insurers may still apply medical necessity standards and cost-sharing requirements. The bill directly affects all health insurance companies and government health programs (such as Medicaid) operating under Pennsylvania's insurance law.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for pelvic floor therapy, expanding patient access to specific treatments under health insurance policies.95% confidence

Sub-Topics Insurance Medicaid

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in committee · Pennsylvania · House May 15, 2025

HB 1470: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for subscription model for GLP-1 agonists.

HB 1470 proposes to amend the Human Services Code to establish a subscription-like model for GLP-1 agonists used to treat obesity within public assistance programs. The bill directs the state department to seek a waiver from the Centers for Medicare and Medicaid Services (CMS) to allow the Commonwealth to enter into value-based arrangements with drug manufacturers. These arrangements are defined as "supplemental rebate agreements," where the Commonwealth pays an agreed amount per treatment up to a cap, after which additional treatments are provided at no cost. If federal approval is granted, the department would then develop regulations to implement this new payment system.

Topics ✓ HealthcareSupports HealthcareEstablishes subscription model for GLP-1 agonists in public assistance via value-based agreements, seeking CMS waiver to improve access to obesity treatment medications within state healthcare programs.92% confidence

Sub-Topics Medicaid Medicare

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