The following is an update of selected state health policy developments in Pennsylvania from June 16 – 20.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

The Shapiro administration has shared a document with stakeholders outlining the potential impact of H.R. 1, the reconciliation package currently being considered by the U.S. Congress. The assessment primarily addresses the impact on Medicaid coverage. It does not include a detailed overview of the provisions in the reconciliation package related to provider taxes or state directed payments, from which Pennsylvania receives significant funding. 

General Assembly

The state House of Representatives convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity that occurred.

• The House Health Committee met on Monday, June 16 and favorably reported, among other bills, House Bill 1234, which expands the Medical Assistance program to cover blood pressure monitors for home use as a pregnancy-related service on a per pregnancy basis. 

• The House Professional Licensure Committee met on Tuesday, June 17 and favorably reported House Bills 80 and 482, which enable Pennsylvania to join the Audiology and Speech-Language Pathology Interstate Compact and the National Occupational Therapy Licensure Compact respectively, and Senate Bill 115, which requires the Department of Human Services to offer a skills competency exam in lieu of  high school diploma or GED requirements for individuals seeking employment as direct care staff in personal care homes or assisted living residences. 

• The House Insurance Committee met on Tuesday, June 17 and favorably reported House Bill 1445, which prohibits an insurer from denying what would otherwise be a service covered by the policy simply because the health care service was received in a school setting. 

The state House of Representatives and Senate will reconvene in Harrisburg for voting on Monday, June 23.

Department of Human Services 

The Department of Human Services (DHS) has announced the proposed annual case-mix per diem payment rates for state Fiscal Year (FY) 2025-26 for non-public and county nursing facilities that participate in the Medical Assistance (MA) program. Find additional information in this Pennsylvania Bulletin notice. 

DHS has issued Provider Quick Tip #263 regarding the electronic submission process for Office of Medical Assistance Programs’ (OMAP) fee-for-service (FFS) and the Office of Long-Term Living’s (OLTL) and LTC 180-day exception requests and other claims requiring documentation in the Promise Portal. 

Department of Health

The Department of Health (DOH) has announced the Newborn Screening and Follow-up Technical Advisory Board is adding Metachromatic Leukodystrophy (MLD) screening, effective January 1, 2026, to the supplemental conditions mandated for screening and follow-up by commonwealth submitters and follow-up by the commonwealth newborn screening program. Find additional information in this Pennsylvania Bulletin notice.

DOH has published notice of the clinical laboratories approved for the following services.

• • Analyses of Blood or Serum or Both for Controlled Substances
  • Determine Blood Alcohol Content
  • Determine Controlled Substance Content of Urine
  • Perform Blood Lead and/or Erythrocyte Protoporphyrin Determinations 

Independent Fiscal Office 

The Independent Fiscal Office (IFO) has published a document outlining the impact of the Medicaid provisions included in the federal reconciliation bill passed by the U.S. House of Representatives. The document also includes a budget brief highlighting Pennsylvania Medicaid enrollment and funding trends from FY 2018-19 through the Shapiro administration’s proposal for FY 2025-26. 

Insurance Department 

The Pennsylvania Insurance Department (PID) has announced that most health insurers are requesting significant premiums increases for plan year 2026. On average, insurers are asking for a 19 percent increase to premiums in the individual market, and a 13 percent increase to premiums in the small group market. 

Around the State  

• State Senate Majority Leader Joe Pittman (R-Indiana) has stated he, “sees no practical way that a budget will be completed on June 30.” His comments and the significant increase in funding for the Medicaid program were the subject of an article by the Pennsylvania Capital-Star. 

• The Pew Charitable Trusts has published an article about the share of state budgets spent on Medicaid and which states have increased their own resources on Medicaid.

• A CBS3 report has highlighted insurance denials and called attention to the Pennsylvania Insurance Department’s external review process for claim denials.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – June 25

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on June 25 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – June 26

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on June 26 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

PHC4 – Council Meeting – July 3

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced it will hold a council meet on July 3 at 10:00 a.m. PHC4 will also hold an Education Committee meeting on June 25. Find additional information in this Pennsylvania Bulletin notice. 

DOH – Newborn Screening Advisory Board – July 24

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, July 24 from 10:00 a.m. until 12:00 p.m. The meeting will be conducted in person only. Find additional details and information on how to participate in this Pennsylvania Bulletin notice. 

DOH – Health Research Advisory Committee – July 30

The Health Research Advisory Committee will hold a public meeting on Wednesday, July 30 from 10:00 a.m. to 11:00 a.m. The meeting will be held at the Nesquehoning Recreational Center. Find additional details on how to participate in this Pennsylvania Bulletin notice. 

DOH – Brain Injury Advisory Board – August 1

The Brain Injury Advisory Board will hold a public meeting on Friday, August 1 from 10:00 a.m. to 3:00 p.m. The meeting will be held in person at the Pennsylvania Training and Technical Assistance Network. Find additional details on how to participate in this Pennsylvania Bulletin notice.