How HB 1721 changes current law

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

The bill establishes medical assistance coverage for peer recovery support services for individuals with mental health or substance use disorders under the Pennsylvania Human Services Code.

• Section 443.16

  Medical Assistance Coverage for Peer Recovery Support Services.--(a) Peer recovery support services are compensable under the medical assistance program in accordance with the Commonwealth's approved State plan for individuals with a mental health disorder or substance use disorder through a licensed provider or through a certified peer recovery support services provider. Peer recovery support services are reimbursable as a primary service for individuals with a mild, moderate or severe mental health disorder or substance use disorder and as a primary service for family members of a covered medical assistance beneficiary and require no other diagnosis, condition or preauthorization.

  This addition allows for reimbursement of peer recovery support services under the medical assistance program.

• Section 443.16

  Peer recovery support services delivered by a provider shall be deemed eligible for reimbursement under subsection (a) if supervised by a licensed mental health practitioner, which shall include an appropriately trained and credentialed peer support specialist supervisor.

  This provision establishes supervision requirements for providers of peer recovery support services to ensure eligibility for reimbursement.

• Section 443.16

  The department and the Department of Drug and Alcohol Programs shall promulgate regulations as necessary to implement this section.

  This grants regulatory authority to implement the provisions concerning peer recovery support services.

• Section 443.16

  The regulations shall provide a reasonable mechanism for the establishment of medical necessity for a recipient of peer recovery support services by a certified peer recovery support services provider that authorizes the provider to contract directly with an external licensed mental health practitioner for a proposed recipient assessment and referral.

  This requirement facilitates the assessment and referral process for individuals seeking peer recovery support services.

• Section 443.16

  The regulations shall provide for the certification of a peer recovery support services provider by the department or the Department of Drug and Alcohol Programs that provides peer recovery support services to individuals, family members and loved ones for mental health, substance use or both mental health and substance use.

  This establishes a formal certification process for peer recovery support services providers.

• Section 443.16

  The department shall supervise and facilitate the certification of a peer recovery support services provider for mental health.

  This assigns the responsibility of supervising the certification of mental health peer recovery support services providers to the department.

• Section 443.16

  The Department of Drug and Alcohol Programs shall supervise and facilitate the certification of a peer recovery support services provider for substance use.

  This assigns the responsibility of supervising the certification of substance use peer recovery support services providers to the Department of Drug and Alcohol Programs.

• Section 443.16

  Nothing in this section shall be construed to impede, disallow or modify the conditions of an existing clinically or medically licensed provider on the effective date of this subsection that is authorized to provide peer recovery support services to recipients in the medical assistance program.

  This ensures that existing providers of peer recovery support services can continue their operations unaffected by the new requirements.