Pennsylvania HB 595: 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 behavioral health and physical health services integration.

Bill Text

PRINTER'S NO. 603
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 595
Session of
2025
INTRODUCED BY GROVE, JAMES, M. JONES AND GILLEN,
FEBRUARY 12, 2025
REFERRED TO COMMITTEE ON HEALTH, FEBRUARY 12, 2025
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 behavioral health and physical health services
integration.
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 443.16. Behavioral Health and Physical Health
Services Integration.--(a) The department shall integrate into
the HealthChoices medical assistance managed care program the
following services for medical assistance-eligible persons:
(1) Behavioral health services, including all mental health
and addiction services covered by medical assistance.
(2) Physical health services covered by medical assistance.
(3) All medication and specialty pharmacy drug benefits
covered by medical assistance.
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(b) The department shall implement the integrated medical
assistance managed care program by contracting with managed care
organizations in a manner that:
(1) Ensures that each recipient receives high quality,
comprehensive health care services in the recipient's local
community within the least restrictive setting able to support
the recipient's needs.
(2) Develops strategies to address social determinants of
health.
(3) Provides optimal information exchange to support whole-
person care delivery.
(4) Provides for budget stability and predictability through
defined outcomes, performance and accountability.
(5) Balances the need for quality health care services,
patient satisfaction, prudent financial measures and self-
sufficiency.
(6) Ensures the most efficient and cost-effective health
care services, administrative systems and structures.
(7) Provides for a sustainable and uniform delivery system
across the Commonwealth's departments and agencies.
(8) Offers health care services to assist recipients in
attaining independence or self-care.
(c) The department shall submit the appropriate waiver
proposal to the Centers for Medicare and Medicaid Services for
approval of an amendment to the existing PA 67 waiver under 42
U.S.C. § 1396n(b) (relating to compliance with State plan and
payment provisions) . The department shall submit for approval by
the Centers for Medicare and Medicaid Services the appropriate
waiver to integrate physical and behavioral health services by
October 1, 2025 . The department shall:
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(1) Provide medical assistance integrated benefits through
the most effective model of medical assistance capitated managed
care as determined by the department.
(2) Require mandatory participation in a medical assistance
capitated managed care program for all persons eligible for
medical assistance.
(3) Utilize the procurement process under 62 Pa.C.S. Pt. I
(relating to Commonwealth Procurement Code) for the integrated
program.
(d) As used in this section, the term "behavioral health
services" means mental disorders and substance-related and
addictive disorders. The term does not include intellectual
developmental disorders.
Section 2. This act shall take effect immediately.
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