Healthcare (Medicaid)

Palliative Care Information and Education Program; Palliative Care and Quality of Life Advisory Council established. Directs the Board of Health to include in its regulations a requirement that every hospital, nursing home, and certified nursing facility licensed by the Board (i) establish a system for identifying patients or residents who may benefit from palliative care and (ii) provide information about and facilitate access to appropriate palliative care services for patients or residents experiencing illness, injuries, or conditions that substantially affect quality of life for more than a short period of time. The bill also directs the Department of Health to establish a palliative care consumer and professional information and education program to maximize the effectiveness of palliative care initiatives in the Commonwealth by (a) ensuring that comprehensive and accurate information and education about palliative care is available to the public, health care providers, and health care facilities and (b) implementing such other initiatives related to education about palliative care and the delivery of palliative care services as may be necessary to educate health care professionals and the public about palliative care. The bill further establishes the Palliative Care and Quality of Life Advisory Council to advise the Department on matters related to the establishment, operation, maintenance, and outcomes evaluations of such initiatives. The bill directs the Palliative Care and Quality of Life Advisory Council to study the possibility of establishing a Medicaid benefit for palliative care and the need for a licensure scheme for palliative care providers. The bill further directs the Board of Health to develop a statewide advanced care planning campaign to increase public awareness of available palliative care options.

Health insurance; essential health benefits benchmark plan. Requires the Bureau of Insurance to select a new essential health benefits benchmark plan for the 2028 plan year, or the soonest plan year thereafter as permitted by the Centers for Medicare and Medicaid Services, that includes, in addition to the essential health benefits package included in the existing benchmark plan, coverage for (i) doula care services; (ii) the treatment of iatrogenic infertility; (iii) fertility treatment and diagnosis, including a maximum of three cycles per lifetime of assisted reproductive technology; (iv) hearing aids for individuals of all ages; (v) pasteurized donor human breast milk; (vi) the prophylaxis, diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome; and (vii) the treatment of polycystic ovary syndrome. Such mandate for coverage does not apply to the individual or small group markets. The bill has a delayed effective date pursuant to approval by the Centers for Medicare and Medicaid Services of certain coverage as outlined in the bill. As introduced, this bill was a recommendation of the Health Insurance Reform Commission.

Health insurance; State Plan for Medical Assistance; coverage for prosthetic and custom orthotic devices and components; reports. Amends provisions related to health insurance coverage for prosthetic devices and components to include custom orthotic devices and components. Under the bill, such coverage does not include repair and replacement due to theft or loss and may include more than one prosthetic or custom orthotic device when medically necessary, as determined by an enrollee's provider. The bill prohibits an insurer from denying coverage for a prosthetic or custom orthotic device for an individual with limb loss, limb absence, or limb impairment that would otherwise be covered for a nondisabled individual seeking medical or surgical intervention. The bill requires health plans that provide such coverage to include language describing an enrollee's rights related to coverage for prosthetic and custom orthotic devices and provide a written explanation of any claim denials. The bill also directs the Department of Medical Assistance Services to seek the necessary permissions from the Centers for Medicare and Medicaid Services to provide payment of medical assistance for prosthetic and custom orthotic devices, subject to the same requirements as insurers. Such payment is conditional on the Department obtaining all necessary approvals and federal financial participation. The bill sunsets on July 1, 2027, if such approval and federal financial participation is not obtained. The bill directs the health insurance carriers, the Department of Medical Assistance Services, and any managed care plan administering Medicaid benefits in the Commonwealth to submit reports to the Health Insurance Reform Commission regarding implementation of the provisions of the bill during plan years 2027 and 2028.

Department of Medical Assistance Services; Medicaid billing navigation. Directs the Department of Medical Assistance Services to provide training to local school division staff regarding assisting schools in effectively navigating the laws, policies, rules, regulations, and guidelines governing Medicaid billing for reimbursable services rendered at school sites, including the federal Bipartisan Safer Communities Act, and to ensure that all school divisions are able to fully leverage Medicaid funding opportunities to enhance student health services in the Commonwealth. As introduced, this bill was a recommendation of the School Health Services Committee.