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
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," in public assistance,
4 providing for behavioral health and physical health services
5 integration.
6 The General Assembly of the Commonwealth of Pennsylvania
7 hereby enacts as follows:
8 Section 1. The act of June 13, 1967 (P.L.31, No.21), known
9 as the Human Services Code, is amended by adding a section to
10 read:
11 Section 443.16. Behavioral Health and Physical Health
12 Services Integration.--(a) The department shall integrate into
13 the HealthChoices medical assistance managed care program the
14 following services for medical assistance-eligible persons:
15 (1) Behavioral health services, including all mental health
16 and addiction services covered by medical assistance.
17 (2) Physical health services covered by medical assistance.
18 (3) All medication and specialty pharmacy drug benefits
19 covered by medical assistance.
 1 (b) The department shall implement the integrated medical
2 assistance managed care program by contracting with managed care
3 organizations in a manner that:
4 (1) Ensures that each recipient receives high quality,
5 comprehensive health care services in the recipient's local
6 community within the least restrictive setting able to support
7 the recipient's needs.
8 (2) Develops strategies to address social determinants of
9 health.
10 (3) Provides optimal information exchange to support whole-
11 person care delivery.
12 (4) Provides for budget stability and predictability through
13 defined outcomes, performance and accountability.
14 (5) Balances the need for quality health care services,
15 patient satisfaction, prudent financial measures and self-
16 sufficiency.
17 (6) Ensures the most efficient and cost-effective health
18 care services, administrative systems and structures.
19 (7) Provides for a sustainable and uniform delivery system
20 across the Commonwealth's departments and agencies.
21 (8) Offers health care services to assist recipients in
22 attaining independence or self-care.
23 (c) The department shall submit the appropriate waiver
24 proposal to the Centers for Medicare and Medicaid Services for
25 approval of an amendment to the existing PA 67 waiver under 42
26 U.S.C. § 1396n(b) (relating to compliance with State plan and
27 payment provisions). The department shall submit for approval by
28 the Centers for Medicare and Medicaid Services the appropriate
29 waiver to integrate physical and behavioral health services by
30 October 1, 2025. The department shall:
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 1 (1) Provide medical assistance integrated benefits through
2 the most effective model of medical assistance capitated managed
3 care as determined by the department.
4 (2) Require mandatory participation in a medical assistance
5 capitated managed care program for all persons eligible for
6 medical assistance.
7 (3) Utilize the procurement process under 62 Pa.C.S. Pt. I
8 (relating to Commonwealth Procurement Code) for the integrated
9 program.
10 (d) As used in this section, the term "behavioral health
11 services" means mental disorders and substance-related and
12 addictive disorders. The term does not include intellectual
13 developmental disorders.
14 Section 2. This act shall take effect immediately.
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Statutes/Laws affected:
Printer's No. 0603: P.L.31, No.21