Healthcare (Medicare)

in committee · Pennsylvania · House May 5, 2025

HB 1391: 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, providing for reimbursement for custom-fabricated devices, custom-fitted devices, orthosis, orthotics, over-the-counter prostheses, orthoses and pedorthic devices, prefabricated orthoses, prostheses, prosthetics and components of such devices.

House Bill 1391 amends The Insurance Company Law of 1921 to mandate that individual and group health insurance policies provide coverage for various custom-fabricated, custom-fitted, orthotic, prosthetic, and pedorthic devices. This applies when these devices are prescribed by an authorized medical professional, directly affecting individuals who require such medical aids and the health insurance companies providing their coverage. The bill requires coverage for the fitting, repair, or replacement of these devices, including those used for recreational, organized, or adaptive sports, and allows insurers to require preauthorization while applying standard cost-sharing. Additionally, Medicaid and contracted insurers would reimburse for these devices at Federal Medicare rates.

Topics ✓ HealthcareSupports HealthcareMandates health insurance coverage for prescribed medical devices, expanding patient access to essential orthotics/prosthetics under healthcare policy.95% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · Pennsylvania · House Apr 4, 2025

HB 1152: 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.

HB 1152 requires insurance companies to directly reimburse non-network emergency medical services (EMS) agencies for 911 emergency calls within 45 days at 350% of the Medicare ambulance rate for the same service in the same area. EMS agencies must register with the state annually to qualify for direct payments, and insurers cannot demand contracts to facilitate this reimbursement. The insurer's payment covers the full service cost (excluding the patient's copay, coinsurance, or deductible), so EMS agencies cannot bill patients for the remaining amount. This law applies only to non-network EMS providers offering 911 emergency medical services, unless preempted by federal law.

Topics ✓ HealthcareSupports HealthcareMandates insurers to reimburse non-network EMS at 350% of Medicare rate within 45 days, ensuring emergency service coverage without patient cost shifting, strengthening access to critical healthcare services.95% confidence

Sub-Topics Insurance Medicare

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in committee · Pennsylvania · House Mar 6, 2025

HB 821: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in departmental powers and duties as to licensing, further providing for regulations.

HB 821 amends Pennsylvania's Human Services Code to require the Department of Human Services to add assisted living services and supplemental health care services to the Community HealthChoices Medicaid program within 60 days. This change directly affects licensed assisted living residences, allowing them to become certified as medical assistance providers for these services. The bill mandates that the department submit necessary documentation to the federal Centers for Medicare and Medicaid Services (CMS) to implement the expansion. The policy change will enable these facilities to participate in the state's Medicaid program for covered services. The bill takes effect 60 days after enactment.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid coverage by adding assisted living and supplemental health services to Community HealthChoices, increasing provider access and patient coverage under state Medicaid program.92% confidence

Sub-Topics Long-Term Care Medicaid Medicare

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in committee · Pennsylvania · House May 15, 2025

HB 1470: 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 subscription model for GLP-1 agonists.

HB 1470 proposes to amend the Human Services Code to establish a subscription-like model for GLP-1 agonists used to treat obesity within public assistance programs. The bill directs the state department to seek a waiver from the Centers for Medicare and Medicaid Services (CMS) to allow the Commonwealth to enter into value-based arrangements with drug manufacturers. These arrangements are defined as "supplemental rebate agreements," where the Commonwealth pays an agreed amount per treatment up to a cap, after which additional treatments are provided at no cost. If federal approval is granted, the department would then develop regulations to implement this new payment system.

Topics ✓ HealthcareSupports HealthcareEstablishes subscription model for GLP-1 agonists in public assistance via value-based agreements, seeking CMS waiver to improve access to obesity treatment medications within state healthcare programs.92% confidence

Sub-Topics Medicaid Medicare

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in committee · Pennsylvania · House Jun 25, 2025

HB 1670: 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 hearing aid coverage.

HB 1670 requires health insurance plans in Pennsylvania, including Medicare and Medicaid coverage, to provide hearing aid benefits. Specifically, it mandates that insurers offer at least $2,500 in coverage every three years for hearing aids sold under state registration rules, with benefits applicable to either hearing aid sellers or contracted fitters. This applies to most health insurance policies but excludes dental, vision, Medicare supplements, and other specified plans. The law takes effect 90 days after enactment, impacting insurers and enrollees in covered health plans across the state.

Topics ✓ HealthcareSupports HealthcareMandates hearing aid coverage in health insurance, expanding patient access to a specific healthcare service under state-regulated plans.95% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · Pennsylvania · Senate Apr 4, 2025

SB 537: 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 medical assistance payments for orthotics and prosthetics.

SB 537 would require Pennsylvania's Medicaid program to reimburse providers for custom orthotics (like braces) and prosthetics (like artificial limbs) at rates no lower than the current Medicare fee schedule. This change directly affects Medicaid recipients needing these medical devices and the healthcare providers who supply them. The bill mandates that the state update its reimbursement rates quarterly to match Medicare's current rates for all applicable codes. This policy aligns Pennsylvania's Medicaid payments more closely with federal Medicare standards for these specific medical equipment items.

Topics ✓ HealthcareSupports HealthcareRequires Medicaid to reimburse orthotics/prosthetics at Medicare rates, expanding coverage access for beneficiaries and providers.95% confidence

Sub-Topics Medicaid Medicare

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in committee · Pennsylvania · House Jan 10, 2025

HR 3: A Resolution designating the month of March 2025 as "Endometriosis Awareness Month" in Pennsylvania.

This resolution designates March 2025 as "Endometriosis Awareness Month" in Pennsylvania. It does not create new laws or provide funding but formally recognizes endometriosis - a condition affecting about 10% of women - as a significant health issue. The resolution urges federal lawmakers to increase research funding for endometriosis, review Medicare/Medicaid billing codes to ensure fair reimbursement for surgical treatments, and establish a national awareness month. It directly affects Pennsylvanians by promoting public and medical awareness of endometriosis symptoms and diagnosis challenges, though it has no binding effect on state or federal policy.

Topics ✓ HealthcareSupports HealthcareUrges increased research funding and Medicare/Medicaid billing code reviews to improve endometriosis patient access and reimbursement, advancing healthcare services.95% confidence

Sub-Topics Medicaid Medicare

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in committee · Pennsylvania · House Aug 14, 2025

HB 1802: 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, providing for coverage of COVID-19 vaccines.

HB 1802 requires all health insurance policies issued in Pennsylvania to cover FDA-approved COVID-19 vaccines with no cost-sharing for enrollees. This applies to insurers offering policies covering medical care (excluding accident-only, dental, or Medicare supplement plans), and mandates that government programs like Medicaid must also provide this coverage without deductibles, copays, or coinsurance. The bill defines "cost-sharing" to exclude premiums but includes standard out-of-pocket expenses, ensuring vaccines remain fully covered. It takes immediate effect and prevents insurers from reducing or eliminating this coverage for existing policies. This directly affects Pennsylvania residents with health insurance and the insurers providing those plans.

Topics ✓ HealthcareSupports HealthcareRequires no cost-sharing for FDA-approved COVID-19 vaccines in insurance policies, expanding access to essential healthcare services without deductibles or copays.95% confidence

Sub-Topics Insurance Medicaid Medicare

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in committee · Pennsylvania · House Feb 12, 2025

HR 76: A Resolution urging the Congress of the United States to establish policies that would provide greater access to blood transfusions for hospice patients with blood cancer.

This Pennsylvania House Resolution (HR 76) urges the U.S. Congress to change Medicare reimbursement policies to cover blood transfusions for hospice patients with blood cancer. It highlights that current Medicare pays hospices a fixed daily rate ($34,465.34 annually per patient), which fails to cover the average $2,388 cost per red blood cell unit transfusion - needed twice weekly by most patients. The resolution states this reimbursement gap prevents access to palliative transfusions (used for comfort, not cancer treatment), leading patients to avoid hospice care. It specifically references a 2023 federal bill proposal that aimed to create a separate payment model for transfusions. The resolution has no legal effect but seeks to prompt federal policy changes.

Topics ✓ HealthcareSupports HealthcareUrges Medicare policy change to cover blood transfusion costs for hospice patients, expanding access to necessary palliative care by addressing reimbursement gaps.95% confidence

Sub-Topics Medicare

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