Healthcare (Medicaid)

in committee · Pennsylvania · House Jun 5, 2026

HR 551: A Resolution directing the Joint State Government Commission and Legislative Budget and Finance Committee to examine the reimbursement mechanisms necessary to expand and sustain a robust behavioral health crisis service system in this Commonwealth, specifically analyzing practices of the Medicaid program, Medicare program and private commercial health insurance payors in paying for crisis services and their impact on the sustainability and accessibility of these vital services.

This resolution directs state committees to study how Medicaid, Medicare, and private insurance pay for behavioral health crisis services in Pennsylvania. The investigation aims to understand how current payment methods affect the ability of crisis centers to operate sustainably and provide accessible care. The study will analyze specific financial data, compare reimbursement rates across different payors, and review successful models used in other states. Ultimately, the committees will develop recommendations to improve funding and ensure the long-term viability of these essential services.

Topics ✓ HealthcareSupports HealthcareBill directs committees to examine reimbursement mechanisms to expand and sustain behavioral health crisis services, aiming to improve accessibility and sustainability.85% confidence

Sub-Topics Insurance Medicaid Mental Health

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in committee · Pennsylvania · Senate May 21, 2026

SB 1342: 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 billing.

This bill amends Pennsylvania's Insurance Company Law to establish a direct billing system for nonnetwork emergency medical services (EMS) agencies. It requires insurers to directly reimburse these agencies for dispatched 911 services at a rate of 350% of the Centers for Medicare and Medicaid Services published rate, rather than billing patients directly. The legislation mandates that insurers pay these agencies within 45 days and prohibits them from forcing EMS agencies to sign contracts to receive this reimbursement. Additionally, the bill creates a public registry to track which EMS agencies are eligible for direct payment and restricts how these agencies can solicit donations related to billing practices.

Topics ✓ HealthcareSupports HealthcareBill mandates insurers to directly reimburse EMS agencies, preventing patient billing and improving access to emergency services.85% confidence

Sub-Topics Medicaid Medicare Tags Public Safety

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in committee · Pennsylvania · House Apr 21, 2026

HB 2431: An Act amending the act of November 21, 2016 (P.L.1318, No.169), known as the Pharmacy Audit Integrity and Transparency Act, in enforcements, further providing for scope of enforcement authority.

This bill expands the enforcement powers of Pennsylvania's Pharmacy Audit Integrity and Transparency Act to address how Pharmacy Benefit Managers handle Medicaid prescriptions. It directly affects PBMs, pharmacies, and pharmacists by requiring PBMs to accept and process prescriptions from any pharmacy or pharmacist that is in good standing with state regulators. The law prohibits PBMs from limiting patient access to specific pharmacies based on the PBM's own private contracting choices. These changes are designed to ensure that Medicaid patients can use any qualified pharmacy without facing artificial restrictions imposed by their benefit manager.

Topics ✓ HealthcareSupports HealthcareBill expands enforcement to ensure PBMs accept prescriptions from any pharmacy, directly improving patient access to healthcare services.85% confidence

Sub-Topics Medicaid Prescription Drugs

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in committee · Pennsylvania · House Apr 27, 2026

HB 2456: 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 payments for extraordinary personal care services.

This bill proposes allowing Pennsylvania to pay for special personal care services provided by a family member to a recipient of Medical Assistance. To make this possible, the state would need to request permission from the federal Centers for Medicare and Medicaid Services to cover these costs. The law specifies that the state cannot begin paying for these services until it receives approval from the federal government. The changes would take effect 180 days after the bill is signed into law.

Topics ✓ HealthcareSupports HealthcareBill expands health coverage by enabling state funding for personal care services provided by family members to Medical Assistance recipients.85% confidence

Sub-Topics Medicaid Medicare

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passed · Pennsylvania · Senate Mar 24, 2026

SB 1211: 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 coverage for biomarker testing.

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.

Topics ✓ HealthcareSupports HealthcareBill expands insurance coverage by requiring casualty policies to cover biomarker testing for medical assistance and CHIP enrollees, improving patient access to health services.90% confidence

Sub-Topics Children's Health Insurance Medicaid

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in committee · Pennsylvania · House Mar 18, 2026

HB 2270: An Act amending the act of November 21, 2016 (P.L.1318, No.169), known as the Pharmacy Audit Integrity and Transparency Act, in preliminary provisions, further providing for definitions; and, in pharmacy benefits manager contracts, providing for State pharmacy benefits manager.

This bill amends Pennsylvania's Pharmacy Audit Integrity and Transparency Act to update definitions for "specialty drug" and "spread pricing" while establishing a new role for a State pharmacy benefits manager. The updated definitions clarify which prescription medications qualify as specialty drugs based on cost, handling requirements, and patient needs, while defining spread pricing as when a pharmacy benefits manager charges more than it pays pharmacists. The bill requires the Department of Human Services to select a single third-party administrator to manage all pharmacy benefits for Medicaid recipients by July 2026, ensuring all managed care organizations contract with this designated manager. The procurement process mandates competitive selection with strict conflict-of-interest disclosures to prevent conflicts between the manager and other healthcare entities like pharmacies, drug distributors, or managed care organizations.

Topics ✓ HealthcareSupports HealthcareBill strengthens pharmacy audit transparency and defines spread pricing to protect patients from overcharges, improving healthcare integrity and access.85% confidence

Sub-Topics Medicaid Prescription Drugs

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in committee · Pennsylvania · Senate Mar 12, 2026

SB 1186: An Act amending the act of November 21, 2016 (P.L.1318, No.169), known as the Pharmacy Audit Integrity and Transparency Act, in preliminary provisions, further providing for definitions; and, in pharmacy benefits manager contracts, providing for State pharmacy benefits manager.

This bill amends Pennsylvania's Pharmacy Audit Integrity and Transparency Act to update definitions for specialty drugs and spread pricing, while establishing a new requirement for a single state-run pharmacy benefits manager. The legislation directs the Department of Human Services to select one third-party administrator by July 2026 to manage all pharmacy benefits for Medicaid recipients, replacing the current system where multiple pharmacy benefits managers may handle these services. Managed care organizations receiving Medicaid contracts will be required to use this state pharmacy benefits manager, and the selection process must include competitive bidding and strict conflict-of-interest disclosures to prevent financial entanglements between the manager and other healthcare entities.

Topics ✓ HealthcareSupports HealthcareBill establishes single state-run pharmacy benefits manager to improve transparency and reduce spread pricing, enhancing patient access and protecting against excessive costs.85% confidence

Sub-Topics Medicaid Prescription Drugs

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in committee · Pennsylvania · Senate Feb 24, 2026

SB 1196: 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.

SB 1196 requires Pennsylvania's Medicaid program and commercial health insurers to treat non-opioid pain medications equally to opioid medications. Specifically, it prohibits Medicaid from labeling non-opioid drugs as "nonpreferred" when opioids are preferred and bans insurers from imposing stricter coverage rules, higher costs, or more restrictive prior authorization for non-opioid drugs compared to opioids. The law applies to all FDA-approved pain medications once approved, ensuring patients have equal access to non-opioid options without facing worse insurance terms than opioid alternatives. It takes effect 60 days after enactment.

Topics ✓ HealthcareSupports HealthcareRequires equal Medicaid/commercial insurance coverage for non-opioid vs opioid pain meds, preventing restrictions/costs on safer alternatives and improving patient access to pain management options.95% confidence

Sub-Topics Medicaid Substance Abuse

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in committee · Pennsylvania · Senate Jan 20, 2026

SB 1147: 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 emergency transportation services.

SB 1147 amends Pennsylvania's Human Services Code to update reimbursement rates for emergency ambulance services under Medicaid programs (Fee-for-Service, Capitation, and Community HealthChoices). It requires reimbursement for every loaded mile based on the higher of 2023 Medicare ambulance rates or current Medicaid fees, effective January 1, 2024. For cases where patients refused transport, it sets new rates starting July 1, 2025, using 2025 Medicare rates or updated Medicaid fees. The bill applies retroactively to July 1, 2025, directly affecting licensed ambulance providers serving Medicaid enrollees.

Topics ✓ HealthcareSupports HealthcareIncreases Medicaid reimbursement rates for ambulance services to higher Medicare rates, ensuring adequate funding and access to emergency transport under public health programs.95% confidence

Sub-Topics Medicaid Medicare

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in committee · Pennsylvania · Senate Jan 9, 2026

SB 1113: An Act amending Titles 35 (Health and Safety) and 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for artificial intelligence in facilities, for artificial intelligence use by insurers and for artificial intelligence use by MA or CHIP managed care plans; imposing duties on the Department of Health, the Insurance Department and the Department of Human Services; and imposing penalties.

SB 1113 requires health care facilities, insurers, and Medicaid Advantage/CHIP managed care plans in Pennsylvania to disclose when artificial intelligence (AI) is used for clinical decision making or patient communications. Facilities must provide clear disclosures in writing, on their public website, and include disclaimers for AI-generated communications with instructions to contact a human provider. The bill exempts routine administrative tasks (like scheduling or billing) and communications reviewed by a human from these disclosure rules. It imposes duties on the Departments of Health, Insurance, and Human Services to enforce compliance and sets penalties for violations.

Topics ✓ HealthcareSupports HealthcareMandates AI disclosure in clinical decisions/communications to protect patient rights and transparency, aligning with healthcare protection indicators.95% confidence ✓ TechnologySupports TechnologyMandates AI disclosure in healthcare for transparency, aligning with data privacy protections and consumer safeguards in clinical decisions.90% confidence

Sub-Topics Children's Health Medicaid Artificial Intelligence

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