Positive behavior support facilitators; scope of practice, supervision, and qualifications. Adds positive behavior support facilitators to the professions governed by the Board of Counseling. The bill establishes qualification, scope of practice, and supervision requirements and directs the Board of Counseling to adopt regulations governing positive behavior support facilitators. The bill also directs the Department of Behavioral Health and Developmental Services and the Department of Medical Assistance Services to promulgate regulations that align with the regulations adopted by the Board of Counseling in accordance with the bill.
Health insurance; balance billing protection; emergency medical services vehicle transportation. Prohibits an out-of-network health insurance provider from balance billing any enrollee for transportation provided by an emergency medical services vehicle, defined in the bill as any vehicle, vessel, or aircraft that holds a valid permit issued by the Office of Emergency Medical Services and that is equipped, maintained, or operated to provide emergency medical care or transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless.
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.
Newborn screening requirements; Gaucher disease. Directs the Department of Health to amend regulations to include Gaucher disease under the Commonwealth's newborn screening panel.
Administrative Process Act; exemptions; limitations; appeals of case decisions regarding benefits sought. Specifies that the Administrative Process Act applies to case decisions regarding the grant or denial, including determinations of eligibility and approved levels of service, of Temporary Assistance for Needy Families, Medicaid, Supplemental Nutrition Assistance Program benefits, general relief, auxiliary grants, or state-local hospitalization. The bill also removes provisions limiting review of case decisions to ascertaining whether there was evidence in the agency record to support the case decision of the agency.
Health insurance; treatment of cancer and certain diseases; coverage of certain medications. Requires an insurer, corporation providing preferred provider subscription contracts, or health maintenance organization that provides coverage for drugs approved by the Food and Drug Administration and prescribed for the treatment of cancer or diseases of the blood to allow, at the patient's direction, (i) provider-administered drugs for such treatment to be dispensed by an in-network treating provider consistent with a provider agreement; (ii) provider-administered drugs for such treatment to be dispensed by an in-network treating provider when there is a documented delay of at least three days in the delivery of a medication from the designated specialty pharmacy; and (iii) self-administered drugs for such treatment to be sent to the pharmacy of the patient's choosing.
Use of artificial intelligence system by mental health service providers; civil penalty. Permits the use of an artificial intelligence system by mental health service providers to assist in providing therapy or counseling services if such mental health service provider maintains full responsibility for all interactions, outputs, and data use associated with the system. The bill prohibits the use of an artificial intelligence system to provide therapy or counseling services without a mental health service provider. The bill specifies that records kept by mental health service providers must comply with health records privacy requirements; creates an exception for religious counseling, peer support, or self-help materials and educational resources; and establishes a civil penalty not to exceed $10,000 for violations of the statute.
Nursing homes; periodic medical visits and resident assessments. Requires all nursing homes to notify the resident of a nursing home, the resident's family, and the Department of Health if a federally required physician visit does not take place. The bill also requires each nursing home to conduct a comprehensive assessment on an annual basis to determine each resident's needs and describe each resident's capability to perform daily life functions. Such assessments must be reviewed at least once every 92 days, and more frequently in the event of a significant change in the resident's physical or mental condition.
Health carriers; use of artificial intelligence; disclosures. Requires health carriers to disclose to the State Corporation Commission's Bureau of Insurance how artificial intelligence is used to manage claims coverage and to submit all information enabling decisions made by artificial intelligence to the Bureau upon request. The bill also requires health carriers to provide notice to enrollees and health care providers when artificial intelligence has been used to issue an adverse determination and to provide a clear and timely process for appeal of such determination.
Department of Behavioral Health and Developmental Services; Early Intervention Program for Infants and Toddlers with Disabilities; program extension. Directs the Department of Behavioral Health and Developmental Services to take all steps necessary to implement the federal extension option for the federal Early Intervention Program for Infants and Toddlers with Disabilities to allow children five years of age or younger to receive services through such program.