Medicare supplement policies; regulations establishing minimum standards; work group; report. Amends provisions related to the State Corporation Commission's issuance of regulations to establish minimum standards regarding Medicare supplement policies to include minimum standards for the disclosure of methodology used in coverage decisions. The bill directs the Bureau of Insurance to convene a work group to review and make recommendations related to minimum standards regarding Medicare supplement policies, implementation of risk adjustment mechanisms, ways to eliminate waste and abuse from overpayments, methodologies used in coverage decisions, ways to improve care under such policies, and the effectiveness and utilization of existing consumer protections related to Medicare supplement policies and to submit a report of its findings and recommendations by December 1, 2026.
Department of Medical Assistance Services; expedited review process for Medicaid service authorization requests; report. Directs the Department of Medical Assistance Services to (i) implement expedited review of Medicaid service authorization requests consistent with applicable federal law and (ii) annually transmit the prior authorization report required by the Centers for Medicare and Medicaid Services to the Chairs of the House Committees on Appropriations and Health and Human Services and the Senate Committees on Finance and Appropriations and Education and Health.
Department of Medical Assistance Services; Family Access to Medical Insurance Security Plan; literacy pilot program. Directs the Department of Medical Assistance Services to seek the necessary permissions from the Centers for Medicare and Medicaid Services to authorize and fund a pilot program promoting early literacy and parental bonding as part of routine pediatric primary care visits in select underserved localities through a partnership with Reach Out and Read.
Inspection of certified nursing facilities; compliance with federal reporting requirements; civil penalty. Directs the Department of Health to include validation of compliance with federal reporting requirements in its inspection process for certified nursing facilities. The bill requires certified nursing facilities to submit a quarterly report detailing (i) all self-reported incidents and compliance issues submitted to the Centers for Medicare and Medicaid Services during the preceding quarter; (ii) any corrective actions taken in response to self-reported incidents; and (iii) updates on ongoing investigations related to reported incidents. The Department may impose a penalty on a certified nursing facility that fails to comply with the reporting requirements imposed by the bill, which may include a civil penalty not to exceed $1,000, increased frequency of inspections, and suspension or revocation of the certified nursing facility's license.
Department of Medical Assistance Services; community health worker expansion. Directs the Department of Medical Assistance Services, in coordination with the Department of Health, Department of Social Services, Department of Behavioral Health and Developmental Services, and Department for Aging and Rehabilitative Services, to (i) evaluate opportunities for Medicaid managed care organizations to embed certified community health workers into care coordination models, (ii) evaluate the implementation of 2024 Medicare Community Health Integration services codes, (iii) develop and implement statewide workforce pathways for community health worker training, and (iv) identify opportunities to expand the use of community health workers in programs supporting high-cost Medicaid populations. The bill directs the Department of Medical Assistance Services to submit a report of its findings and recommendations to the Joint Commission on Health Care and the Chairs of the House Committee on Appropriations and Senate Committee on Finance and Appropriations no later than December 1, 2026.
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.
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.
