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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| SENATE BILL |
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| INTRODUCED BY ORIE, PILEGGI, EARLL, MENSCH, PIPPY, RAFFERTY, WAUGH AND D. WHITE, APRIL 8, 2011 |
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| REFERRED TO PUBLIC HEALTH AND WELFARE, APRIL 8, 2011 |
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| AN ACT |
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1 | Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An |
2 | act to consolidate, editorially revise, and codify the public |
3 | welfare laws of the Commonwealth," further providing for |
4 | medical assistance benefit packages and Medicaid managed care |
5 | organizations; and making inconsistent repeals. |
6 | The General Assembly of the Commonwealth of Pennsylvania |
7 | hereby enacts as follows: |
8 | Section 1. Section 454(d) of the act of June 13, 1967 |
9 | (P.L.31, No.21), known as the Public Welfare Code, added July 7, |
10 | 2005 (P.L.177, No.42), is amended and the section is amended by |
11 | adding a subsection to read: |
12 | Section 454. Medical Assistance Benefit Packages; Coverage, |
13 | Copayments, Premiums and Rates.--* * * |
14 | (c.1) (1) Notwithstanding any other provision of this law |
15 | or any other law to the contrary, a Medicaid managed care |
16 | organization may customize benefit packages for Medicaid |
17 | recipients as provided in this subsection. |
18 | (2) The authority to customize benefit packages as provided |
19 | in this subsection shall not apply to: |
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1 | (i) Medicaid recipients who are twenty-one years of age or |
2 | younger; |
3 | (ii) Medicaid recipients who are pregnant; or |
4 | (iii) any federally mandated benefits. |
5 | (3) The following conditions shall apply to the creation of |
6 | customized benefit packages pursuant to this subsection: |
7 | (i) Customized benefit packages shall reflect the various |
8 | Medicaid categories for which recipients may qualify under the |
9 | Medicaid program. |
10 | (ii) The department may not adjust premiums paid to a |
11 | Medicaid managed care organization based on the authority to |
12 | customize benefit packages as provided in this subsection. |
13 | (iii) Customized benefit packages offered pursuant to this |
14 | subsection may not exceed one-half of one percent of the total |
15 | premium paid to the Medicaid managed care organization, |
16 | excluding the Medicaid managed care organization assessment made |
17 | pursuant to the former Article VIII-B and any future assessment |
18 | imposed on managed care organizations. |
19 | (iv) A Medicaid managed care organization shall submit to |
20 | the department a copy of each customized benefit package to be |
21 | offered and any future modifications to be made to any |
22 | customized benefit package, together with an actuarial study |
23 | demonstrating that the customized benefit package or |
24 | modification is actuarially sound. |
25 | (v) A Medicaid managed care organization shall: |
26 | (A) submit the information required by subparagraph (iv) to |
27 | the department no later than September 1 of the year prior to |
28 | which the Medicaid managed care organization intends to offer |
29 | the benefit package or modification; and |
30 | (B) not offer the customized benefit package or modification |
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1 | to recipients prior to June 30 of the year following submission |
2 | to the department of the information required by subparagraph |
3 | (iv). |
4 | (d) As used in this section: |
5 | "Adult" means recipients twenty-one years of age or older, |
6 | except when in relation to copayments, for which the term means |
7 | recipients eighteen years of age or older. |
8 | "Benefit packages" means the list of items and services |
9 | covered by medical assistance, including any limitations on |
10 | covered items and services. |
11 | "Medicaid managed care organization" means a Medicaid managed |
12 | care organization as defined in section 1903(m)(1)(A) of the |
13 | Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(m)(1)(A)) |
14 | that is a party to a Medicaid managed care physical health |
15 | contract with the department. |
16 | Section 2. All acts and parts of acts are repealed insofar |
17 | as they are inconsistent with this act. |
18 | Section 3. This act shall take effect July 1, 2011, or |
19 | immediately, whichever is later. |
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