Healthcare

Prior authorization; requiring physician review for denial. Prohibits a health insurance carrier from making an adverse determination of a prior authorization request (i) for prescription drugs unless such denial has been reviewed and approved by a licensed physician or, if a licensed physician is not available, by a licensed pharmacist or (ii) for health care services unless such adverse determination has been reviewed and approved by (a) a licensed physician; (b) in the case of mental health services, a licensed mental health provider if a licensed physician is unavailable; or (c) in the case of dental services, a licensed dentist if a licensed physician is unavailable.

Health insurance; reimbursement rates. Requires health insurance carriers to reimburse in-network providers for covered mental health services and outpatient treatment at rates negotiated between the health carrier and the in-network provider, provided that such rates are no less than 100 percent of the applicable reimbursement rate under Medicare for the same provider and service.

Health insurance; claims experience information. Provides that provisions requiring insurers to provide policyholders with certain claims experience information apply to all employee welfare benefit plans and include pharmacy benefits claims.

Health insurance; requirements for certain opioid antagonists. Requires each health insurer, corporation providing health care subscription plans, and health maintenance organization whose policy, contract, or plan includes coverage for prescription drugs to include coverage for at least one other opioid antagonist used for overdose reversal dispensed pursuant to an oral, written, or standing order of a prescriber and ensure that cost-sharing for at least one opioid antagonist used for overdose reversal is included on the lowest cost tier of the insurer's, corporation's, or health maintenance organization's prescription drug formulary. The bill provides that such coverage shall be exempt from any prior authorization or step therapy requirement on coverage of benefits. As introduced, this bill was a recommendation of the Joint Commission on Health Care. This bill is identical to SB 257.

Health care planning; statewide emergency medical services system and services; provision of emergency medical services for events. Requires the Department of Health to publish on its website a document for event planners and event venues to provide to prospective clients containing (i) notice that emergency medical services personnel may be made available for events, (ii) information regarding the benefits of appropriate medical support for large or high-risk events, and (iii) a list of emergency medical services providers available to provide services at event venues in each locality of the Commonwealth.

Nursing homes and assisted living facilities; licensure; automated external defibrillators. Requires nursing homes and assisted living facilities to have and maintain an automated external defibrillator and have staff trained to use such automated external defibrillator.

Health care; decision-making; end of life; penalties. Allows an adult diagnosed with a terminal disease to request and an attending health care provider to prescribe a self-administered controlled substance for the purpose of ending the patient's life. The bill requires that a patient's request for a self-administered controlled substance to end his life be given orally on two occasions and in writing, signed by the patient and one witness, and that the patient be given an express opportunity to rescind his request at any time. The bill makes it a Class 2 felony (i) to willfully and deliberately alter, forge, conceal, or destroy a patient's request, or rescission of request, for a self-administered controlled substance to end his life with the intent and effect of causing the patient's death; (ii) to coerce, intimidate, or exert undue influence on a patient to request a self-administered controlled substance for the purpose of ending his life or to destroy the patient's rescission of such request with the intent and effect of causing the patient's death; or (iii) to coerce, intimidate, or exert undue influence on a patient to forgo a self-administered controlled substance for the purpose of ending the patient's life. The bill also grants immunity from civil or criminal liability and professional disciplinary action to any person who complies with the provisions of the bill and allows health care providers to refuse to participate in the provision of a self-administered controlled substance to a patient for the purpose of ending the patient's life.

State employee health insurance plan; coverage for prosthetic devices. Provides that the plan established by the Department of Human Resource Management for the provision of health insurance coverage for state employees shall include coverage for medically necessary prosthetic devices and their repair, fitting, replacement, and components.

Health Care Decisions Act; patients incapable of making informed decisions; absence of next of kin. Authorizes, for purposes of the Health Care Decisions Act, the patient care consulting committee to make health care decisions for a patient incapable of making informed decisions when no next of kin is reasonably available.

Developmental disability waivers; financial eligibility standards; sunset repeal. Repeals the July 1, 2026, sunset on provisions directing the Department of Medical Assistance Services to disregard Social Security Disability Insurance income above the maximum monthly Supplemental Security Income when determining financial eligibility for developmental disability waivers.