Bill Text: PA SB995 | 2009-2010 | Regular Session | Introduced

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Bill Title: Further providing for medical assistance benefit packages and Medicaid managed care organizations; and making inconsistent repeals.

Spectrum: Partisan Bill (Republican 8-0)

Status: (Introduced - Dead) 2009-07-06 - Referred to PUBLIC HEALTH AND WELFARE [SB995 Detail]

Download: Pennsylvania-2009-SB995-Introduced.html

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PRINTER'S NO. 1254
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 995 Session of2009
INTRODUCED BY ORIE, BROWNE, PILEGGI, RAFFERTY, WAUGH, M. WHITE, EARLL AND D. WHITE, JULY 6, 2009
REFERRED TO PUBLIC HEALTH AND WELFARE, JULY 6, 2009
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," further providing for
medical assistance benefit packages and Medicaid managed care
organizations; and making inconsistent repeals.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 454(d) of the act of June 13, 1967
(P.L.31, No.21), known as the Public Welfare Code, added July 7,
2005 (P.L.177, No.42), is amended and the section is amended by
adding a subsection to read:
Section 454. Medical Assistance Benefit Packages; Coverage,
Copayments, Premiums and Rates.--* * *
(c.1) (1) Notwithstanding any other provision of this law
or any other law to the contrary, a Medicaid managed care
organization may customize benefit packages for Medicaid
recipients as provided in this subsection.
(2) The authority to customize benefit packages as provided
in this subsection shall not apply to:
(i) Medicaid recipients who are twenty-one years of age or
younger; or
(ii) Medicaid recipients who are pregnant; or
(iii) to any federally mandated benefits.
(3) The following conditions shall apply to the creation of
customized benefit packages pursuant to this subsection:
(i) Customized benefit packages shall reflect the various
Medicaid categories for which recipients may qualify under the
Medicaid program.
(ii) The department may not adjust premiums paid to a
Medicaid managed care organization based on the authority to
customize benefit packages as provided in this subsection.
(iii) Customized benefit packages offered pursuant to this
subsection may not exceed one-half of one percent of the total
premium paid to the Medicaid managed care organization,
excluding the Medicaid managed care organization assessment made
pursuant to the former Article VIII-B and any future assessment
imposed on managed care organizations.
(iv) A Medicaid managed care organization shall submit to
the department a copy of each customized benefit package to be
offered and any future modifications to be made to any
customized benefit package, together with an actuarial study
demonstrating that the customized benefit package or
modification is actuarially sound.
(v) A Medicaid managed care organization shall:
(A) submit the information required by subparagraph (iv) to
the department no later than September 1 of the year prior to
which the Medicaid managed care organization intends to offer
the benefit package or modification; and
(B) not offer the customized benefit package or modification
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to recipients prior to June 30 of the year following submission
to the department of the information required by subparagraph
(iv).
(d) As used in this section:
"Adult" means recipients twenty-one years of age or older,
except when in relation to copayments, for which the term means
recipients eighteen years of age or older.
"Benefit packages" means the list of items and services
covered by medical assistance, including any limitations on
covered items and services.
"Medicaid managed care organization" means a Medicaid managed
care organization as defined in section 1903(m)(1)(A) of the
Social Security Act (49 Stat. 620, 42 U.S.C. § 1396(m)(1)(A))
that is a party to a Medicaid managed care physical health
contract with the department.
Section 2. All acts and parts of acts are repealed insofar
as they are inconsistent with this act.
Section 3. This act shall take effect July 1, 2009, or
immediately, whichever is later.
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