The following is an update of selected state health policy developments in Pennsylvania from June 23 – 27.  (Some of the language used below is taken directly from state documents). 

General Assembly

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

• The Senate unanimously voted to concur with the House’s amendments to Senate Bill 411, which provides the ability for the Pennsylvania Department of Health to create and utilize a stroke registry. The bill will now be sent to Governor Shapiro’s desk for his signature.

• The Senate unanimously passed House Bill 640, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP). The amended bill will now be sent back to the House for concurrence.

• The Senate unanimously passed House Bill 309, which amends the Osteopathic Medical Practice Act to allow team physicians traveling internationally with their club or national team to treat their own players on site during games without needing a Pennsylvania medical license. The amended bill will now be sent back to the House for concurrence.

• The Senate passed Senate Bill 715, which extends the Rare Disease Advisory Council’s sunset date to 2028. The bill was subsequently sent to the House and referred to the Health Committee.

• The Senate passed Senate Bill 88, which provides coverage for supplemental screenings and diagnostic examinations without cost-sharing if a patient is at average risk or higher for breast cancer. The bill was subsequently sent to the House and favorably reported out of the Insurance Committee.

• The House of Representatives passed House Bill 1100, which creates a grant program to provide eligible public-school entities with funding to acquire and distribute menstrual hygiene products. The bill will now be sent to the Senate for consideration.

• The House of Representatives passed 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 bill was subsequently sent to the Senate and referred to the Banking & Insurance Committee.

• The House of Representatives passed House Bill 1590, which supports Pennsylvania’s implementation of a new federal Medicaid flexibility that waives the longstanding “four walls” requirement for outpatient behavioral health clinics. The bill will now be sent to the Senate for consideration.

• The House of Representatives passed House Bill 583, which requires the Department of Human Services to establish a benefit package for dental services for Medicaid. The bill was subsequently sent to the Senate and referred to the Health & Human Services Committee.

• The House of Representatives passed House Bill 1442, which places requirements on coroners to report Sudden Unexpected Death in Epilepsy (SUDEP). The bill was subsequently sent to the Senate and referred to the Local Government Committee.

The House and Senate will reconvene on Monday, June 30 for voting session.

Department of Human Services

• The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to notify providers that it will begin using Milliman Clinical Guidelines (MCG) as the screening guidelines to determine medical necessity for services, items, procedures, or level of care provided to Medical Assistance (MA) beneficiaries, effective July 18, 2025. 

• DHS has also issued a Medical Assistance Bulletin to advise providers of changes to the MA program fee schedule. The department is adding and end-dating codes as a result of the 2025 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS). The changes are effective for dates of service on and after June 16, 2025. 

• DHS has announced the proposed assessment amount, the proposed assessment methodology, and the estimated aggregate impact on nursing facilities that will be subject to the assessment under the Nursing Facility Assessment Program beginning in Fiscal Year (FY) 2025-2026. Find additional information in this Pennsylvania Bulletin notice. 

• The Office of Long-Term Living (OLTL) has shared an alert from the Centers for Medicare & Medicaid Services (CMS) about a fraud scheme that uses phishing fax requests, which falsely claim to be from CMS staff, to obtain medical records and documentation for auditing purposes.

• DHS has issued a revised MA 549 form to use for dental benefit limit exception (BLE) requests. Find additional information in this Medical Assistance Bulletin. 

Department of Health

The Department of Health (DOH), in partnership with the Pennsylvania Insurance Department and the Department of Human Services has launched a public survey looking for feedback on and suggestions for improving women’s health care across the commonwealth. The 10-minute survey is open through July 7 and focuses on women’s preventive health care, like health screenings, birth control, pregnancy care, and mental health services. 

Independent Fiscal Office

The Independent Fiscal Office (IFO) has published a revised document updating its prior impact of the Medicaid provisions included in the federal reconciliation bill package being negotiated by the U.S. Congress. 

Department of State 

The Department of State has announced that Pennsylvania will become a full participant in three health care compacts – physician, nursing, and physical therapy – beginning July 7. Click the respective compact link for more information regarding its implementation. 

Department of Aging

The Department of Aging has announced that it is conducting an evaluation of the PA Link to inform the design of a strategic plan to refresh and improve the program to better serve older adults, people with disabilities, and caregivers. Find additional information in this Pennsylvania Bulletin notice. 

State Board of Nursing 

The State Board of Nursing has released proposed regulations implementing Act 60 of 2021, which establishes title protection for certified registered nurse anesthetists (CRNA). Find the proposed rulemaking in this Pennsylvania Bulletin notice.

State Board of Pharmacy 

The State Board of Pharmacy has issued final-form rulemaking to effectuate Act 140 of 2020, which establishes criteria for pharmacy technician training programs as well as the standards of practice and registration fees for both pharmacy technicians and pharmacy technician trainees. Find the final rulemaking in this Pennsylvania Bulletin notice. 

Around the State  

The Philadelphia Inquirer has published an article about the Pennsylvania Medicaid program’s cost growth and its role in current state budget talks.

Stakeholder Meetings

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 – HIV Planning Committee – July 16-17

The Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee has announced it will hold a virtual public meeting on Wednesday, July 16 and Thursday, July 17. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Renal Disease Advisory Committee – July 18

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, July 18.  The purpose of the meeting is to discuss new and ongoing issues relating to treatment of chronic renal disease and the Department of Health’s programs related to care and treatment. Find information on how to participate in this Pennsylvania Bulletin notice.

DOH – Special Pharmaceutical Benefits Program Advisory Council – July 31

The Special Pharmaceutical Benefits Program Advisory Council will hold a public meeting on Thursday, July 31. The SPBP Advisory Council will provide program guidance and recommendations to the Department’s SPBP in regard to the following: drug formulary; covered lab services; drug utilization review; clinical programs; eligibility and program management. Find details on how to participate in this Pennsylvania Bulletin notice.