Pennsylvania SB 1316: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for pending medical assistance applications.

Bill Text

PRINTER'S NO. 1671
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1316
Session of
2026
INTRODUCED BY J. WARD, LAUGHLIN, STEFANO, VOGEL, HUTCHINSON,
CULVER, BAKER, BARTOLOTTA AND BOSCOLA, MAY 1, 2026
REFERRED TO HEALTH AND HUMAN SERVICES, MAY 1, 2026
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
providing for pending medical assistance applications.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
Section 449.3. Pending Medical Assistance Applications.--(a)
The department shall develop and implement a standardized
process to be adhered to by all county assistance offices when a
medical assistance application for long-term care services is
received. The process must include the following requirements:
(1) Prior to rendering a decision on a medical assistance
application, the caseworker assigned to the application shall:
(i) Review and take into account all submitted documentation
related to the individual's eligibility for long-term care
medical assistance.
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(ii) Use all resources and tools available, including the
Asset Verification System, to obtain documentation necessary to
make an informed decision on the application.
(iii) If, after considering and reviewing all submitted
documentation and other accessible information available,
additional documentation is needed, no later than ten days from
the date of the application, send a pending letter to the
provider electronically, advising the provider of the following:
(A) a list of any specific outstanding documentation needed
to render an informed decision on the application;
(B) direct contact information for the caseworker assigned
to the application; and
(C) a time frame to submit the outstanding documentation
requested.
(iv) Communicate weekly with the provider, using a
standardized electronic communication template developed by the
department to provide status of the application and specify any
outstanding documentation needed to process the application.
(2) When a medical assistance application for long-term care
services is denied, the caseworker assigned to the application
shall:
(i) Honor the provider's request for a reconsideration of
the denial and, within ten days of receipt of related documents,
review and take appropriate action on the application. If, as a
result of the review of the information, the application can be
approved, approve the application and issue a notice of
eligibility to the provider within seven calendar days. If the
application cannot be approved, send an electronic notice
stating the reason for the denial and any additional information
or documentation that is needed.
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(ii) Review and act on any newly submitted documentation
subsequent to a request for a fair hearing within ten days of
receipt of the documentation. If, as a result of the review of
the new documentation, the application can be approved, approve
the application and issue a notice of eligibility to the
provider within seven calendar days.
(3) Regardless of the status of the medical assistance
application for long-term care services, including pending,
denied, appealed or under stipulation, the caseworker assigned
to the application shall review and act on all submitted
documentation within ten days of receipt. If, after review of
the documentation, the application can be approved, issue an
eligibility notice to the provider within seven calendar days.
(4) No later than ninety days following the end of each
calendar year, the department shall issue a public report, for
the prior calendar year, to the chair of the Health and Human
Services Committee of the Senate and the chair of the Human
Services Committee of the House of Representatives that includes
the following information from county assistance offices:
(i) The total number of medical assistance applications for
long-term care services submitted.
(ii) The total number of medical assistance applications for
long-term care services approved on initial determination.
(iii) The total number of medical assistance applications
for long-term care services denied on initial determination and
approved through the appeal process.
(iv) The total number of medical assistance applications for
long-term care services approved for uncompensated care
payments.
(v) The total number of medical assistance applications for
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long-term care services approved for uncompensated care payments
but denied on final determination.
(5) The report under paragraph (4) shall be