Healthcare

Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.

Weapons; possession prohibited in a hospital that provides mental health services or developmental services; penalty. Makes it a Class 1 misdemeanor for any person to knowingly and intentionally possess in the building of any hospital that provides mental health services or developmental services in the Commonwealth, including an emergency department or other facility rendering emergency medical care, a (i) firearm, (ii) knife with a blade over three and one-half inches, or (iii) other dangerous weapon, including explosives and stun weapons. The bill also provides that notice of such prohibitions shall be posted conspicuously at each public entrance of any hospital and that no person shall be convicted of the offense if such notice is not posted, unless such person had actual notice of the prohibitions. The bill provides that such firearm, knife, explosive, or weapon shall be subject to seizure by a law-enforcement officer and forfeited to the Commonwealth and specifies certain exceptions to the prohibition. This bill is identical to HB 229.

Drug manufacturers; 340B Drug Pricing Program; work group; report. Directs the Secretary of Health and Human Resources to convene a work group to conduct a comprehensive evaluation of the impacts of the federal 340B Drug Pricing Program within the Commonwealth, with emphasis on governance, transparency, and the availability of pharmacy services in rural and underserved areas. The bill requires the work group to submit a report on its findings and recommendations to the Chairs of the Senate Committees on Finance and Appropriations and Education and Health and the House Committees on Appropriations and Health and Human Services by November 1, 2026.

Department of Health; reduction of opioid overdose and opioid overdose deaths; report. Directs the Department of Health to develop a strategic plan for opioid overdose response to reduce rates of drug overdose and drug overdose deaths in the Commonwealth and to provide a report on the status of such strategic plan and its implementation to the Governor, the Chairs of the House Committees on Appropriations and Health and Human Services and the Senate Committees on Education and Health and Finance and Appropriations, and the Joint Commission on Health Care by November 1, 2026, and annually thereafter. As introduced, this bill was a recommendation of the Joint Commission on Health Care. This bill is identical to HB 794.

Active Pharmaceutical Ingredient Manufacturing Grant Fund. Establishes the Active Pharmaceutical Ingredient Manufacturing Grant Fund to provide grant installment awards between July 1, 2026, and July 1, 2045, in an amount not to exceed $15 million per fiscal year and in an aggregate amount not to exceed $130 million, to a qualified company that (i) engages in the manufacture of pharmaceutical substances, (ii) executes a memorandum of understanding with the Commonwealth, and (iii) is expected to make a capital investment of at least $2,148,793,019 and create and maintain at least 468 new full-time jobs. This bill is identical to HB 800.

Comprehensive crisis system; Marcus alert system; Department of Behavioral Health and Developmental Services; comprehensive mental health, substance abuse, and developmental disability crisis services; written plan. Allows the Department of Behavioral Health and Developmental Services, in collaboration with the Department of Criminal Justice Services, to amend the written plan created pursuant to relevant law after the publication of such written plan, provided that (i) the stakeholders listed in relevant law are consulted during the development of any new language to be added to such written plan and (ii) a public comment period of no less than 30 days is held prior to the finalization of such written plan. The bill also provides that the written plan shall serve as the operational framework for relevant components of the comprehensive crisis system and the Marcus alert system and that state agencies and local implementing partners shall align their policies, procedures, and operations on an ongoing basis with the requirements and guidance set forth in the written plan, as amended. As introduced, this bill was a recommendation of the Behavioral Health Commission. This bill is identical to HB 453.

Prescription Drug Affordability Advisory Panel established; maximum fair price; annual reports; civil penalties. Directs the Secretary of Health and Human Resources to establish the Prescription Drug Affordability Advisory Panel to conduct data analyses, develop policy recommendations, and identify implementation barriers related to strategies to improve prescription drug affordability, enhance price transparency, and strengthen data collection practices for prescription drugs across public and private payers. The bill requires the Panel to (i) report annually on prescription drug pricing trends and any policy recommendations on legislation to improve prescription drug affordability and (ii) provide quarterly updates on prescription drug pricing trends. The bill requires each pharmacy benefits manager to provide to the Panel, upon request, certain information relating to the dispensation of a referenced drug, as defined in the bill.The bill prohibits prescription drug manufacturers or wholesale distributors permitted or licensed in the Commonwealth from accepting payment at an amount higher than the maximum fair price established by the U.S. Secretary of Health and Human Services pursuant to federal law for the sale of a referenced drug intended for use by individuals in the Commonwealth. Under the bill, an entity that violates such prohibition is subject to a civil penalty of $10,000 per violation. The bill also prohibits a manufacturer subject to its provisions from removing a referenced drug from sale distribution in the Commonwealth for the purpose of avoiding the impact of the bill's rate limitations without providing certain prior notice. Under the bill, a manufacturer that violates such prohibition on removing a referenced drug without the required notice is subject to a civil penalty equal to the greater of $100,000 or the total amount of annual savings for the referenced drug, as determined by the Board of Pharmacy. This bill is identical to SB 271.

Comprehensive crisis system; Marcus alert system; Department of Behavioral Health and Developmental Services; comprehensive mental health, substance abuse, and developmental disability crisis services; written plan. Allows the Department of Behavioral Health and Developmental Services, in collaboration with the Department of Criminal Justice Services, to amend the written plan created pursuant to relevant law after the publication of such written plan, provided that (i) the stakeholders listed in relevant law are consulted during the development of any new language to be added to such written plan and (ii) a public comment period of no less than 30 days is held prior to the finalization of such written plan. The bill also provides that the written plan shall serve as the operational framework for relevant components of the comprehensive crisis system and the Marcus alert system and that state agencies and local implementing partners shall align their policies, procedures, and operations on an ongoing basis with the requirements and guidance set forth in the written plan, as amended. As introduced, this bill was a recommendation of the Behavioral Health Commission. This bill is identical to SB 513.

Active Pharmaceutical Ingredient Manufacturing Grant Fund. Establishes the Active Pharmaceutical Ingredient Manufacturing Grant Fund to provide grant installment awards between July 1, 2026, and July 1, 2045, in an amount not to exceed $15 million per fiscal year and in an aggregate amount not to exceed $130 million, to a qualified company that (i) engages in the manufacture of pharmaceutical substances, (ii) executes a memorandum of understanding with the Commonwealth, and (iii) is expected to make a capital investment of at least $2,148,793,019 and create and maintain at least 468 new full-time jobs. This bill is identical to SB 404.

Pharmaceutical Substance Manufacturing Grant Fund. Establishes the Pharmaceutical Substance Manufacturing Grant Fund to provide grant installment awards between July 1, 2026, and July 1, 2045, in an amount not to exceed $34 million per fiscal year and in an aggregate amount not to exceed $191,255,000, to a qualified company that (i) engages in the manufacture of pharmaceutical substances, (ii) executes a memorandum of understanding with the Commonwealth, and (iii) is expected to make a capital investment of at least $4 billion and create and maintain at least 500 new full-time jobs. This bill is identical to SB 527.