Healthcare (Medicaid)

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

Track

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

Track

in committee · Pennsylvania · House Jun 25, 2025

HB 1670: 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, further providing for hearing aid coverage.

HB 1670 requires health insurance plans in Pennsylvania, including Medicare and Medicaid coverage, to provide hearing aid benefits. Specifically, it mandates that insurers offer at least $2,500 in coverage every three years for hearing aids sold under state registration rules, with benefits applicable to either hearing aid sellers or contracted fitters. This applies to most health insurance policies but excludes dental, vision, Medicare supplements, and other specified plans. The law takes effect 90 days after enactment, impacting insurers and enrollees in covered health plans across the state.

Topics ✓ HealthcareSupports HealthcareMandates hearing aid coverage in health insurance, expanding patient access to a specific healthcare service under state-regulated plans.95% confidence

Sub-Topics Insurance Medicaid Medicare

Track

in committee · Pennsylvania · Senate Apr 4, 2025

SB 537: 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 payments for orthotics and prosthetics.

SB 537 would require Pennsylvania's Medicaid program to reimburse providers for custom orthotics (like braces) and prosthetics (like artificial limbs) at rates no lower than the current Medicare fee schedule. This change directly affects Medicaid recipients needing these medical devices and the healthcare providers who supply them. The bill mandates that the state update its reimbursement rates quarterly to match Medicare's current rates for all applicable codes. This policy aligns Pennsylvania's Medicaid payments more closely with federal Medicare standards for these specific medical equipment items.

Topics ✓ HealthcareSupports HealthcareRequires Medicaid to reimburse orthotics/prosthetics at Medicare rates, expanding coverage access for beneficiaries and providers.95% confidence

Sub-Topics Medicaid Medicare

Track

in committee · Pennsylvania · House Apr 7, 2025

HB 1154: An Act amending the act of April 9, 1929 (P.L.343, No.176), known as The Fiscal Code, in general budget implementation, further providing for Department of Health.

HB 1154 requires Pennsylvania's Department of Health to develop and implement a mobile application targeting Medicaid-eligible individuals for pregnancy, prenatal, postpartum, and infant care programs. The app must provide multilingual resources, connect users to state health services, meet clinical standards from major medical organizations, and operate on Android/iOS platforms. The department must select a vendor through competitive bidding within 90 days, paying $10 per user monthly with an annual cap of $500,000. The bill mandates the vendor to report de-identified usage data, including Medicaid eligibility engagement and app interaction metrics, to the department.

Topics ✓ Budget & TaxesSupports Budget & TaxesMandates $10/user monthly state expenditure for health app, directly increasing budget allocation for public health services per bill's funding mechanism.95% confidence ✓ HealthcareSupports HealthcareRequires mobile app for Medicaid-eligible prenatal/postpartum care access, expanding healthcare services and patient connectivity through state-funded program expansion.95% confidence

Sub-Topics Procurement Medicaid

Track

in committee · Pennsylvania · House Jan 10, 2025

HR 3: A Resolution designating the month of March 2025 as "Endometriosis Awareness Month" in Pennsylvania.

This resolution designates March 2025 as "Endometriosis Awareness Month" in Pennsylvania. It does not create new laws or provide funding but formally recognizes endometriosis - a condition affecting about 10% of women - as a significant health issue. The resolution urges federal lawmakers to increase research funding for endometriosis, review Medicare/Medicaid billing codes to ensure fair reimbursement for surgical treatments, and establish a national awareness month. It directly affects Pennsylvanians by promoting public and medical awareness of endometriosis symptoms and diagnosis challenges, though it has no binding effect on state or federal policy.

Topics ✓ HealthcareSupports HealthcareUrges increased research funding and Medicare/Medicaid billing code reviews to improve endometriosis patient access and reimbursement, advancing healthcare services.95% confidence

Sub-Topics Medicaid Medicare

Track

in committee · Pennsylvania · House Aug 14, 2025

HB 1802: 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 of COVID-19 vaccines.

HB 1802 requires all health insurance policies issued in Pennsylvania to cover FDA-approved COVID-19 vaccines with no cost-sharing for enrollees. This applies to insurers offering policies covering medical care (excluding accident-only, dental, or Medicare supplement plans), and mandates that government programs like Medicaid must also provide this coverage without deductibles, copays, or coinsurance. The bill defines "cost-sharing" to exclude premiums but includes standard out-of-pocket expenses, ensuring vaccines remain fully covered. It takes immediate effect and prevents insurers from reducing or eliminating this coverage for existing policies. This directly affects Pennsylvania residents with health insurance and the insurers providing those plans.

Topics ✓ HealthcareSupports HealthcareRequires no cost-sharing for FDA-approved COVID-19 vaccines in insurance policies, expanding access to essential healthcare services without deductibles or copays.95% confidence

Sub-Topics Insurance Medicaid Medicare

Track

in committee · Pennsylvania · House Jan 22, 2025

HB 216: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in fraud and abuse control, further providing for definitions and for provider prohibited acts, criminal penalties and civil remedies.

HB 216 amends Pennsylvania's Human Services Code to strengthen fraud and abuse controls in the medical assistance program (Medicaid). It adds a definition of "Representation" to clarify communications used for billing or determining reimbursement rates, and updates prohibited acts to explicitly include making false or misleading statements in claims or records. The bill expands specific prohibitions to cover submitting claims for medically unnecessary services, misrepresenting services provided, or billing for non-rendered care. These changes directly affect healthcare providers and practitioners who bill the state's Medicaid program by providing clearer standards for compliance. The amendments aim to improve enforcement of existing penalties without creating new ones.

Topics ✓ HealthcareSupports HealthcareBill strengthens Medicaid fraud controls by clarifying billing definitions and expanding prohibitions against false claims, protecting healthcare program integrity and funding.92% confidence

Sub-Topics Medicaid

Track

in committee · Pennsylvania · House Jun 24, 2026

HB 1827: An Act providing for medical assistance coverage and insurance coverage of screening, prevention and treatment measures for osteoporosis as a result of menopause.

This bill requires Medicaid programs and private health insurance plans to cover bone density screenings, preventive care, and treatments for osteoporosis specifically linked to menopause. It directly affects postmenopausal women, particularly those with low income who rely on Medicaid, by ensuring access to these services without cost barriers. The key provision mandates that both public medical assistance programs and private insurers include these osteoporosis-related services in standard coverage. This expands existing coverage to explicitly address menopause-related bone health needs.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid/private insurers to cover osteoporosis screenings/treatment for postmenopausal women, removing cost barriers and expanding access to preventive care.95% confidence

Sub-Topics Insurance Medicaid Primary Care

Track

in committee · Pennsylvania · House Dec 3, 2025

HB 2060: 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 pain parity in Medicaid and for pain parity in commercial insurance.

HB 2060 requires Pennsylvania's Medicaid program and private commercial insurers to provide equal coverage for non-opioid and opioid medications used to treat pain. It prohibits insurers from designating non-opioid pain drugs as "non-preferred" when opioids are preferred, imposing stricter prior authorization requirements on non-opioids, or placing non-opioids in higher-cost tiers than opioids. The law applies immediately to any FDA-approved pain medication, affecting Medicaid beneficiaries and private insurance customers across Pennsylvania. This policy change ensures that patients have equal access to both non-opioid and opioid treatment options without discriminatory coverage barriers.

Topics ✓ HealthcareSupports HealthcareRequires equal Medicaid/commercial insurance coverage for pain meds, preventing insurers from restricting non-opioid options and improving patient access to alternatives.95% confidence

Sub-Topics Medicaid Substance Abuse

Track