SB 1373
An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in fraud and abuse control, further providing for definitions and for restrictions on provider charges and payments and providing for claim submissions.
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Sign in to take action- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Bill overview
This bill updates Pennsylvania’s Human Services Code to strengthen fraud and abuse control within the medical assistance program. It clarifies definitions related to claims, recipients, and providers, including the use of National Provider Identifiers (NPIs). The bill also introduces new requirements for submitting claims, including detailed information about services provided, and establishes a training program to combat Medicaid fraud.
Key provisions
- Defines ‘Claim,’ ‘National Provider Identifier’ (NPI), and ‘Recipient’ within the medical assistance program.
- Requires providers of home and community healthcare services (not billed as per diem) to obtain a National Provider Identifier (NPI).
- Mandates that claims submitted for these services include the provider’s NPI, Medicaid provider number, dates, and times of service.
- Establishes a standardized training program for providers and financial management services to recognize and prevent Medicaid fraud.
- Updates reporting requirements to align with the 21st Century Cures Act.
- Requires electronic visit information to include data from electronic visit verification systems.
- Allows the department to deny claims for noncompliance with reporting requirements.
- Specifies a timeframe for the Department of Human Services to develop and implement rules related to the bill’s provisions.
Who is affected
- Healthcare providers
- Medical assistance recipients
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
Daniel Laughlin
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