Regular Session 2023-2024 House Bill 1596 P.N. 1877

PRINTER'S NO. 1877

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1596

Session of

2023

INTRODUCED BY STRUZZI, ECKER AND GROVE, AUGUST 7, 2023

REFERRED TO COMMITTEE ON HUMAN SERVICES, AUGUST 7, 2023

AN ACT

Amending the act of April 9, 1929 (P.L.177, No.175), entitled

"An act providing for and reorganizing the conduct of the

executive and administrative work of the Commonwealth by the

Executive Department thereof and the administrative

departments, boards, commissions, and officers thereof,

including the boards of trustees of State Normal Schools, or

Teachers Colleges; abolishing, creating, reorganizing or

authorizing the reorganization of certain administrative

departments, boards, and commissions; defining the powers and

duties of the Governor and other executive and administrative

officers, and of the several administrative departments,

boards, commissions, and officers; fixing the salaries of the

Governor, Lieutenant Governor, and certain other executive

and administrative officers; providing for the appointment of

certain administrative officers, and of all deputies and

other assistants and employes in certain departments, boards,

and commissions; providing for judicial administration; and

prescribing the manner in which the number and compensation

of the deputies and all other assistants and employes of

certain departments, boards and commissions shall be

determined," in Independent Fiscal Office, providing for

medical assistance managed care payment analysis.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The act of April 9, 1929 (P.L.177, No.175), known

as The Administrative Code of 1929, is amended by adding a

section to read:

Section 616-B. Medical assistance managed care payment

analysis.

(a) Annual capitated payment rates.--Beginning in 2025 and

each year thereafter, the office shall develop capitated payment

rates for the physical health medical assistance managed care

program and the managed long-term services and supports program

for the subsequent calendar year. The rates developed by the

office shall comply with 42 CFR Ch. IV Subch. C Pt. 438

(relating to managed care) and be sufficient to maintain the

services and benefits offered through the physical health

medical assistance managed care program and the managed long-

term services and supports program as of March 1 of each year.

The office shall adopt the rate development methodology,

including adjustments or payment arrangements in use by the

department at the time of developing the annual rates.

(b) Submission.--By May 1, 2025, and May 1 of each year

thereafter, the office shall submit the capitated payment rates

developed under subsection (a) to the Governor and the General

Assembly. The following shall apply:

(1) The submission for the physical health medical

assistance managed care program shall include the following:

(i) The cost components of the rates, by rating

region and rate cell, including:

(A) The cost of the minimum medical services

required to be offered under Federal law or

regulation, by category of service.

(B) The cost of any optional medical service

offered, by category of service.

benefit offered, by service or benefit.

(D) The administrative cost component and a

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description of the administrative requirements of the

physical health medical assistance managed care

organizations.

(E) The underwriting gain component.

(F) Any other applicable rate component.

(ii) A description of the rate development

methodology, including adjustments or payment

arrangements.

(2) The submission for the managed long-term services

and supports program shall include the following:

(i) The cost components of the rates, by rating

region and rate cell, including:

(A) The cost of medical services, by category of

service.

(B) The cost of home and community-based waiver

services, by category of service.

description of the administrative requirements of the

managed long-term services and supports managed care

organizations.

(D) The underwriting gain component.

(E) Any other applicable rate component.

(ii) A description of the rate development

methodology, including adjustments or payment

arrangements.

experience developing and evaluating managed Medicaid capitated

payment rates to fulfill its duties under subsection (a).

(d) Access to documents and data.--The office shall have

access to all documents and data of the department and medical

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assistance managed care organizations it deems necessary to

fulfill its duties under this section, including prior year

encounter data from the physical health medical assistance

managed care program and the managed long-term services and

supports program.

(e) Confidential information.--The office shall maintain

confidential or proprietary business information or data of the

department or a medical assistance managed care organization.

Information or data disclosed or produced by the department or a

medical assistance managed care organization under subsection

(d) for the use of the office shall not be subject to access

under the act of February 14, 2008 (P.L.6, No.3), known as the

Right-to-Know Law.

(f) Definitions.--As used in this section, the following

words and phrases shall have the meanings given to them in this

subsection unless the context clearly indicates otherwise:

"Department." The Department of Human Services of the

Commonwealth.

"Medical assistance managed care organization." A Medicaid

managed care organization, as defined under 42 U.S.C. § 1396b(m)

(1)(A) (relating to payment to States), that is a party to a

Medicaid managed care contract with the department for the

physical health medical assistance managed care program or the

managed long-term services and supports program.

Section 2. This act shall take effect in 60 days.

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