Healthcare

Health insurance; tobacco surcharge. Eliminates the authority of a health carrier to vary its premium rates based on tobacco use. Under current law, a health carrier may charge premium rates up to 1.5 times higher for a tobacco user than for a nonuser. The provisions of the bill apply to health benefit plans providing individual or small group health insurance coverage entered into, amended, extended, or renewed on or after January 1, 2027. This bill is identical to HB 220.

Life insurance; health insurance; unfair discrimination; pre-exposure prophylaxis for prevention of human immunodeficiency virus. Prohibits any person from refusing to insure, refusing to continue to insure, or limiting the amount or extent of life insurance or accident and sickness insurance coverage available to an individual or charge an individual a different rate for the same coverage based solely on the status of such individual as having received pre-exposure prophylaxis for the prevention of human immunodeficiency virus.

Health care providers; required estimate for nonemergency health care services. Requires health care providers to provide a good faith estimate of the payment amount for which the patient will be responsible for such nonemergency health care service, including any fees or other charges for an item or service the patient may reasonably be expected to receive in connection with the nonemergency health care service. The bill requires the good faith estimate to include (i) description of the scheduled nonemergency health care service, (ii) the provider's standard charge for the service and any related item or service, (iii) the provider's standard charges and any contracted rates known at the time the estimate is prepared, and (iv) a statement that the estimate is not binding and the actual amount billed may differ depending on changes in the scope of services or the health carrier's processing of the claim.

Department of Medical Assistance Services; Department of Social Services; administration of medical assistance and social services programs; technology modernization; report. Directs the Department of Social Services (DSS) and the Department of Medical Assistance Services (DMAS) to contract with a third-party vendor to study and create a plan for the modernization of the technological systems used to administer federal benefit programs in the Commonwealth. The bill requires DSS and DMAS to develop and submit a legislative report that includes a plan to modernize the current technological systems to the Governor and the Chairs of the House Committee on Health and Human Services and the Senate Committee on Rehabilitation and Social Services by December 1, 2026, and to use the recommendations and plan outlined in such legislative report to move forward with the procurement process.

Department of Medical Assistance Services; Medicaid waivers; consumer-directed services; employer of record. Directs the Department of Medical Assistance Services (DMAS) to modify the program rules for consumer-directed services available through certain Medicaid waivers to allow an individual receiving services to serve as the employer of record (EOR) for his own service delivery and designate another individual to perform all or a portion of the duties of the EOR on the individual's behalf when the individual receiving services is unable to perform such duties or direct his own care. The bill specifies that when an individual (i) has not yet reached the age of majority, (ii) is ineligible to use his existing employer identification number (EIN) to facilitate the taxation of benefits, or (iii) is otherwise determined to be ineligible by DMAS by administrative rule, the EIN shall be assigned to the individual receiving services and shall not be transferred to another individual. Under the bill, DMAS has the authority to limit such amendments to specify that an individual receiving services may make such designation no more than twice per calendar year.

Department of Medical Assistance Services; Medicaid estate recoveries. Directs the Department of Medical Assistance Services (the Department) to limit the operation of its estate recovery program to the recovery of only federally required costs. The bill directs the Department to make information on estate recovery available on its website in multiple languages. The bill directs the Department to adopt emergency regulations to implement the provisions of the bill.

Department of Medical Assistance Services; enhanced oversight of services facilitators. Directs the Department of Medical Assistance Services to enhance oversight of Medicaid services facilitation for consumer directed services, including incorporation of such services into the statewide Fiscal Employer Agent contract and development of a contract monitoring and oversight plan.

Firefighters Cancer Screening Grant Program and Fund established. Creates the Firefighters Cancer Screening Grant Program and Fund to award grants to localities for costs incurred in providing certain cancer detection tests to firefighters. The bill provides that in any year that the amount of funds in the Firefighters Cancer Screening Fund reduces to zero and the Fund does not receive a separate appropriation, the Grant Program and Fund shall expire.

Fees for vehicles designed and used for transportation of passengers; funds returned to a locality; permitted uses. Expands the permitted use of funds returned to a locality from certain vehicle fees to include the purchase or maintenance of necessary equipment, supplies, facilities, and vehicles permitted by the Office of Emergency Medical Services and other operating expenses deemed necessary by the locality to ensure the provision of emergency medical services in such locality by nonprofit emergency medical services agencies. Under current law, such funds may be used for the purchase of necessary equipment and supplies for use in the locality for emergency medical services provided by nonprofit emergency medical services agencies.