Pennsylvania SB 1289: An Act providing for patient access to clear health care information; and requiring plain-language summaries of coverage, prior authorization and appeal rights.

Bill Text

PRINTER'S NO. 1606
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1289
Session of
2026
INTRODUCED BY KEEFER, COLEMAN AND VOGEL, APRIL 17, 2026
REFERRED TO HEALTH AND HUMAN SERVICES, APRIL 17, 2026
AN ACT
Providing for patient access to clear health care information;
and requiring plain-language summaries of coverage, prior
authorization and appeal rights.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Patient
Right-to-Understand Act.
Section 2. Legislative intent.
The General Assembly finds and declares as follows:
(1) Patients in this Commonwealth frequently receive
complex or unclear health care information that prevents
informed decision making.
(2) Prior authorization rules, coverage limitations,
billing practices and appeal procedures are often
communicated in legal or technical language.
(3) Transforming health care decisions requires patients
and purchasers to be able to ask:
(i) How much does it cost?
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(ii) Do I need this?
(iii) Is this decision being made within the bounds
of a doctor-patient relationship only?
(4) A system grounded in access, care, time,
transparency and trust, known as the Five Pillars of Hope,
restores value, efficiency and confidence for patients,
businesses and communities.
(5) It is the intent of the General Assembly to promote
a health care environment in which patients are educated,
empowered, engaged and encouraged to participate actively in
their health decisions, to understand the health care
marketplace and the cost of care and to make choices grounded
in trust and transparency within the doctor-patient
relationship. A system that supports informed decision
making, strengthens communities, improves outcomes and allows
individuals and businesses to direct health care dollars
toward care that meets their needs.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Health care entity." An insurer, managed care organization,
hospital, health system, medical practice or third-party
administrator operating in this Commonwealth that submits claims
for reimbursement to an insurer or health benefit plan for
covered health care services. The term does not include a health
care practice that does not submit insurance claims for
reimbursement and that is compensated through direct patient or
employer payment arrangements, including membership,
subscription, bundled or marketplace-facilitated payments.
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"Plain language." Information communicated in everyday
terms, using short sentences and examples, free of legal or
technical jargon, written at no higher than a sixth-grade
reading level.
Section 4. Patient right-to-understand requirements.
(a) Plain-language summary.--A health care entity shall
provide to each patient a plain-language summary of:
(1) coverage basics, including deductibles, copayments,
coinsurance, facility and professional fees and network
restrictions;
(2) prior authorization requirements, including
timelines and appeal rights;
(3) appeal processes for denied services; and
(4) expected out-of-pocket costs, based on a good faith
estimate, for nonemergent services.
(b) Electronic summary.--A health care entity shall provide
the summary under subsection (a) electronically upon enrollment
or renewal of a health insurance policy and upon patient
request.
(c) Format and accessibility standards.--A summary required
under subsection (a) shall:
(1) be concise, prominently displayed and designed to
facilitate patient understanding;
(2) not exceed two pages in length;
(3) use standardized headings and plain-language
formatting; and
(4) present information in a clear, organized manner
that enables patients to readily compare coverage, costs and
options.
Section 5. Coverage versus care.
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A health care entity shall provide a plain-language statement
distinguishing between:
(1) what is covered by insurance; and
(2) what constitutes medical care decisions made solely
between a patient and a health care practitioner.
Section 6. Patient choice and options disclosure.
(a) Disclosure of care and payment options.--A health care
entity shall provide information describing legally available
care and payment options, including:
(1) cash-pay pricing;
(2) health savings accounts;
(3) employer-funded spending accounts; and
(4) out-of-network care options.
(b) Endorsement not required.--A health care entity may not
require endorsement of any option to receive disclosure under
subsection (a).
Section 7. Enforcement.
A health care entity that fails to provide the required
summaries under this act and a ce