SB 1371 — An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for enrollment limitation.

Bill Text

• Printer's No. PN1776 View text Current pdf

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

The bill modifies the enrollment requirements for managed care plans, allowing eligible persons to change plans under specified circumstances.

• Section 458

  Upon → (a) Except as provided under subsection (b), upon

  This change clarifies that the enrollment obligation of at least twelve months applies except in certain situations.

• Section 458

  without cause during the ninety-day period following the later of: (i) the date of the eligible person's initial enrollment; or (ii) the date that the department sends the eligible person notice of enrollment;

  This addition allows new enrollees a grace period to change their managed care plan without needing to provide a reason.

• Section 458

  without cause during an annual enrollment opportunity, for which the department shall provide notice at least sixty days in advance;

  This adds a provision for annual enrollment opportunities where enrollees can change plans without cause.

• Section 458

  for good cause at any time.

  This addition allows individuals to change their managed care plan at any time if they have a valid reason.

• Section 458

  Good cause under subsection (b)(3) shall be limited to the following causes for disenrollment:

  This specifies and limits the conditions under which a disenrollment can occur for 'good cause.'

• Section 458

  A determination of good cause shall be supported by documentation or other information sufficient for the department to validate the basis for the request.

  This requires documentation to support claims for disenrollment based on 'good cause.'

• Section 458

  Nothing in this section shall be construed to permit a general or categorical waiver of subsection (a) permitting eligible persons to change managed care plans at any time without cause unless required by Federal law or approved by statute.

  This clarifies that the standard enrollment period cannot be waived indiscriminately.

• Section 458

  The department shall establish procedures for notice, review and appeal of a denial of a plan-change request under this section.

  This mandates the creation of procedures to handle appeals related to enrollment changes.

• Section 458

  The secretary shall seek any amendment, modification, renewal or approval of a waiver authorized under section 1915(b) of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396n(b)) or other Federal authority necessary to implement this section, including any amendment, modification, renewal or approval necessary to establish an enrollment limitation, annual plan selection period and good cause transfer process consistent with 42 CFR 438.56 (relating to disenrollment: requirements and limitations).

  This requires coordination with federal authorities to align state rules with federal requirements regarding enrollment processes.

Action History

1. June 05, 2026

   Referred to Health & Human Services

Sponsors

• Dawn W. Keefer · Primary

Subjects