Pennsylvania 2025-2026 Regular Session Status: In Committee Bipartisan · 4 R · 2 D cosponsors

HB 544 — An Act providing for the use of certain credentialing applications and for credentialing requirements for health insurers; imposing penalties; and conferring powers and imposing duties on the Insurance Department.

Last action — Referred to Insurance

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill is in committee in the House. Introduced February 10, 2025. It must pass committee before a floor vote.

Next likely step: a committee vote, then a floor vote in the House.

Prognosis

Advancing 42% · moderate confidence

Where this bill stands today.

Odds of enactment

Low

How often bills like it became law.

  • In Committee

    Current position in the legislative process.

  • 6 sponsors

    1 primary, 5 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (4 R · 2 D) — cross-party backing.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Bill Text

How this bill changes current law

8 changes Share ↗

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

This act establishes new requirements for health insurers in Pennsylvania regarding the credentialing of health care practitioners using the CAQH credentialing application.

  • Section 3

    All health insurers licensed to do business in this Commonwealth shall be required to accept the CAQH credentialing application or other form designated by the Insurance Department so long as the form is nationally recognized as an appropriate credentialing application when submitted by a health care practitioner for participation in the health insurer's provider panel.

    Health insurers must accept the CAQH credentialing application for practitioner participation.

  • Section 4

    (a) Notice.--Within 10 business days after receiving a CAQH credentialing application, the health insurer shall notify the health care practitioner in writing on whether the application is complete or incomplete. The health insurer shall state the reasons why the application is incomplete within the time frame specified under this subsection. (b) Issuance.--The health insurer shall issue a credentialing determination within 45 business days after receiving a complete CAQH credentialing application. When a health care practitioner is not credentialed by a health insurer, the health insurer shall notify the health care practitioner in writing of the reasons for the decision within the time frame specified under this subsection.

    Health insurers must promptly notify practitioners about the status of their credentialing applications.

  • Section 4

    (c) Automatic credentialing.--Upon approving a health care practitioner's complete CAQH credentialing application with practices in multiple locations, the health care practitioner shall be automatically credentialed to serve in the health insurer's provider panel in all locations.

    Practitioners approved in one location are automatically credentialed in others for the same insurer.

  • Section 5

    The Insurance Department shall assess an administrative penalty on a health insurer for failure to utilize CAQH, or other designated application, or for intentionally and routinely failing to complete the credentialing process according to section 4. A health insurer may not be subject to an administrative penalty based on a health care practitioner's failure to use or complete an accurate CAQH credentialing application.

    Insurers may face penalties for failing to follow credentialing requirements.

  • Section 6

    Nothing in this act shall be construed to guarantee the rights of a health care practitioner to participate in any health insurer network in this Commonwealth nor require a health insurer to accept any willing health care provider to an insurance network.

    The act does not guarantee that practitioners will be included in insurer networks.

  • Section 7

    The Insurance Department shall promulgate rules and regulations to administer and enforce this act.

    The Insurance Department is tasked with creating regulations for implementing the act.

  • Section 8

    All acts and parts of acts are repealed insofar as they are inconsistent with this act.

    Conflicting laws are repealed to ensure consistency with this new act.

  • Section 9

    This act shall take effect in 180 days.

    The act will be enforceable 180 days after its enactment.

Action History

  1. Referred to Insurance

Sponsors

Sponsorship breakdown

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1 sponsors · 5 co-sponsors · 247 not signed on

Sponsors (1)

Co-sponsors (5)

Not signed on (247)

247 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors HB 544?
HB 544 is sponsored by Steven C. Mentzer (Republican), Brad Roae (Republican), R. Lee James (Republican), Jeremy Shaffer (Republican), Lindsay Powell (Democratic), and Paul Friel (Democratic).
What is the current status of HB 544?
This bill is in committee in the House. Introduced February 10, 2025. It must pass committee before a floor vote.
Where can I track HB 544?
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