SB 1371
An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for enrollment limitation.
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Sign in to take action- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Bill overview
This bill amends Pennsylvania’s Human Services Code to establish enrollment limitations for public assistance programs. Specifically, it requires individuals enrolled in managed care plans to maintain that enrollment for at least twelve months unless a specific waiver is granted. The bill outlines circumstances that would qualify as ‘good cause’ for a change in managed care plan, such as moving out of the service area, plan dissatisfaction with coverage, or issues related to accessing necessary services. It also details the procedures for requesting and appealing plan changes.
Key provisions
- Requires managed care plan enrollment to be maintained for at least 12 months unless a waiver is granted.
- Establishes ‘good cause’ reasons for changing managed care plans, including relocation, coverage disputes, and access to services.
- Outlines procedures for requesting and appealing plan change denials.
- Specifies documentation requirements for demonstrating ‘good cause’ for a plan change.
- Addresses situations involving long-term services and supports, particularly regarding provider changes.
- Includes provisions related to poor quality of care and access to covered services.
- Requires the Department of Human Services to establish notice, review, and appeal procedures.
- Authorizes the Secretary to seek federal waivers and modifications to comply with federal law.
Who is affected
- Individuals receiving public assistance benefits.
- Managed care organizations providing services to public assistance recipients.
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