SB 1360

                                                  PRINTER'S NO.   1796
               THE GENERAL ASSEMBLY OF PENNSYLVANIA
                  SENATE BILL
                  No. 1360
                                            Session of
                                              2026
INTRODUCED BY TARTAGLIONE, J. WARD, FARRY, HAYWOOD, FONTANA,
   PICOZZI, COSTA, SANTARSIERO, VOGEL, BOSCOLA, MILLER,
   CAPPELLETTI, FLYNN, PENNYCUICK, COLLETT AND SCHWANK,
   JUNE 8, 2026
REFERRED TO INSTITUTIONAL SUSTAINABILITY AND INNOVATION,
   JUNE 8, 2026
                               AN ACT
1 Providing for insurance coverage for prostheses and orthoses;
2    and imposing duties on the Insurance Department and the
3    Department of Human Services.
4TABLE OF CONTENTS
5 Chapter 1.   General Provisions
6 Section 101.   Short title.
7 Section 102.   Definitions.
8 Chapter 3.   Insurers
9 Section 301.   Coverage for prostheses and orthoses.
10 Section 302.   Nature of benefits.
11 Section 303.   Determination and prescription.
12 Section 304.   Nondiscriminatory manner.
13 Section 305.   Notification.
14 Section 306.   Financial requirements.
15 Section 307.   Access to other providers.
16 Section 308.   Replacements.
17 Section 309.   Notice by Insurance Department.
1 Section 310.    Reports.
2 Section 311.    Rules and regulations.
3 Section 312.    Enforcement.
4 Chapter 5.   Government Programs
5 Section 501.    Coverage for prostheses and orthoses.
6 Section 502.    Nature of benefits.
7 Section 503.    Determination and prescription.
8 Section 504.    Nondiscriminatory manner.
9 Section 505.    Notification.
10 Section 506.    Financial requirements.
11 Section 507.    Access to other providers.
12 Section 508.    Replacements.
13 Section 509.    Notice by department.
14 Section 510.    Reports.
15 Section 511.    Rules and regulations.
16 Section 512.    Enforcement.
17 Chapter 7.   Miscellaneous Provisions
18 Section 701.    Construction.
19 Section 702.    Applicability.
20 Section 703.    Effective date.
21    The General Assembly of the Commonwealth of Pennsylvania
22 hereby enacts as follows:
23CHAPTER 1
24GENERAL PROVISIONS
25 Section 101.    Short title.
26    This act shall be known and may be cited as the So Every BODY
27 Can Move Act.
28 Section 102.    Definitions.
29    The following words and phrases when used in this act shall
30 have the meanings given to them in this section unless the
20260SB1360PN1796  - 2 -
1 context clearly indicates otherwise:
2    "Cost sharing."     The portion of costs paid by an enrollee for
3 a particular benefit covered by a health insurance policy or MA
4 or CHIP managed care plan, including deductibles, coinsurance,
5 copayments or similar charges.
6    "Department."      The Department of Human Services of the
7 Commonwealth.
8    "Enrollee."      An individual covered under a health insurance
9 policy or MA or CHIP managed care plan.
10    "Health insurance policy."      As follows:
11(1)   An individual or group insurance policy, subscriber
12    contract, certificate or plan offered, issued or renewed by a
13    health insurer that provides medical or health care coverage,
14    including emergency services.
15(2)   The term does not include:
16(i)    An accident only policy.
17(ii)    A credit only policy.
18(iii)    A long-term care or disability income policy.
19(iv)    A specified disease policy.
20(v)    A fixed indemnity policy.
21(vi)    A hospital indemnity policy.
22(vii)    A dental only policy.
23(viii)    A vision only policy.
24(ix)    A workers' compensation policy.
25(x)    An automobile medical payment policy.
26(xi)    A homeowners' insurance policy.
27(xii)    Any other similar policy providing for limited
28benefits.
29    "Health insurer."     An entity licensed by the Insurance
30 Department with accident and health authority to issue a health
20260SB1360PN1796  - 3 -
1 insurance policy that is offered or governed under any of the
2 following:
3(1)   The act of May 17, 1921 (P.L.682, No.284), known as
4    The Insurance Company Law of 1921, including section 630 and
5    Article XXIV of that act.
6(2)   The act of December 29, 1972 (P.L.1701, No.364),
7    known as the Health Maintenance Organization Act.
8(3)   40 Pa.C.S. Ch. 61 (relating to hospital plan
9    corporations) or 63 (relating to professional health services
10    plan corporations).
11    "Medical Assistance or Children's Health Insurance Program
12 managed care plan" or "MA or CHIP managed care plan."    A health
13 care plan that uses a gatekeeper to manage the utilization of
14 health care services by medical assistance or children's health
15 insurance program enrollees and integrates the financing and
16 delivery of health care services.
17    "Medical Practice Act."    The act of December 20, 1985
18 (P.L.457, No.112), known as the Medical Practice Act of 1985.
19    "Medicare fee schedule."    The Medicare Durable Medical
20 Equipment, Prosthetics, Orthotics and Supplies Fee Schedule
21 established by the Centers for Medicare and Medicaid Services.
22    "Provider."    An individual licensed as a prosthetist,
23 orthotist, pedorthist or orthotic fitter under section 13.5 of
24 the Medical Practice Act.
25CHAPTER 3
26INSURERS
27 Section 301.    Coverage for prostheses and orthoses.
28    (a)   Amount of coverage.--Each health insurance policy
29 providing coverage for hospital, medical or surgical expenses
30 must include coverage for prosthetic and custom orthotic
20260SB1360PN1796  - 4 -
1 devices, services, materials and components as described in this
2 act that:
3(1)   Equals the coverage and payment provided under
4    Federal laws and regulations for the aged and people with
5    disabilities in accordance with:
6(i)    42 U.S.C. §§ 1395k (relating to scope of
7benefits; definitions), 1395l (relating to payment of
8benefits) and 1395m (relating to special payment rules
9for particular items and services).
10(ii)    42 CFR 410.100 (relating to included services),
11414.202 (relating to definitions), 414.210 (relating to
12general payment rules) and 414.228 (relating to
13prosthetic and orthotic devices).
14(2)   Equals payment at a rate not less than the current
15    quarter's Medicare fee schedule for prosthetic and orthotic
16    items and services in this Commonwealth.
17    (b)   Multiple prostheses and orthoses.--Subject to section
18 303, benefits under this section shall provide coverage for more
19 than one prosthetic or custom orthotic device when medically
20 necessary and shall include coverage for:
21(1)   A prosthetic or custom orthotic device determined by
22    the enrollee's provider to be the most appropriate model that
23    adequately meets the medical needs of the enrollee to restore
24    or maintain the ability to perform activities of daily living
25    and essential job-related functions.
26(2)   In addition to coverage described in paragraph (1),
27    a prosthetic or custom orthotic device determined by the
28    enrollee's provider to be the most appropriate model that
29    meets the medical needs of the enrollee for the purposes of:
30(i)    performing physical activities, including
20260SB1360PN1796  - 5 -
1running, biking, swimming and strength training, as
2applicable; and
3(ii)   maximizing whole-body health, including lower
4and upper limb function, as applicable.
5(3)     In addition to coverage described in paragraphs (1)
6    and (2), a prosthetic or custom orthotic device determined by
7    the enrollee's provider to be the most appropriate model that
8    meets the medical needs of the enrollee for purposes of
9    showering or bathing.
10(4)     Materials and components necessary for use of a
11    prosthetic or custom orthotic device described in paragraphs
12    (1), (2) and (3).
13(5)     Instruction to the enrollee on the use of a
14    prosthetic or custom orthotic device described in paragraphs
15    (1), (2) and (3).
16(6)     The medically necessary repair or replacement of a
17    prosthetic or custom orthotic device described in paragraphs
18    (1), (2) and (3).
19 Section 302.    Nature of benefits.
20    Any benefits delivered, issued for delivery or renewed in
21 this Commonwealth by a health insurance policy under section
22 301:
23(1)     Shall also be considered rehabilitative and
24    habilitative services and devices in accordance with 42
25    U.S.C. § 18022(b) (relating to essential health benefits
26    requirements).
27(2)     Shall not constitute an addition to the State's
28    essential health benefits that requires defrayal of costs by
29    the State in accordance with 42 U.S.C. § 18031(d)(3)(B)
30    (relating to affordable choices of health benefit plans).
20260SB1360PN1796  - 6 -
1 Section 303.      Determination and prescription.
2    For covered benefits under section 301(b)(2) or (3), the
3 physician, podiatrist, certified registered nurse practitioner
4 or physician assistant of the enrollee shall:
5(1)    Determine that, as applicable, the additional
6    prosthetic or custom orthotic device is necessary to meet the
7    medical needs of the enrollee to:
8(i)    perform physical activities or maximize whole-
9body health, as specified in section 301(b)(2); or
10(ii)   shower or bathe, as specified in section 301(b)
11(3).
12(2)    Issue a prescription for the additional prosthetic
13    or custom orthotic device in accordance with section 13.5(c)
14    of the Medical Practice Act.
15 Section 304.      Nondiscriminatory manner.
16    A health insurer:
17(1)    Shall render utilization review determinations in a
18    nondiscriminatory manner.
19(2)    May not deny coverage for prosthetic or custom
20    orthotic devices solely on the basis of an enrollee's actual
21    or perceived disability.
22(3)    May not deny a prosthetic or orthotic benefit for an
23    enrollee with limb loss or absence that would otherwise be
24    covered for a person without a disability seeking medical or
25    surgical intervention to restore or maintain the ability to
26    perform the same physical activity.
27 Section 305.      Notification.
28    (a)   Provision.--A health insurer shall supply each enrollee
29 annually and, upon written request, each enrollee or health care
30 provider with the following written notification of the benefits
20260SB1360PN1796  - 7 -
1 specified under section 301 and the rights specified under
2 section 304. The information shall be easily understandable by
3 the layperson.
4    (b)     Adverse benefit determination.--Following an adverse
5 benefit determination based on medical necessity and prior to
6 any appeal of an adverse benefit determination, a health insurer
7 shall provide an enrollee or enrollee's authorized
8 representative with a denial in writing. The denial shall
9 include clear reasoning and descriptions as to why the standard
10 of medical necessity has not been met.
11 Section 306.     Financial requirements.
12    (a)     Prohibition.--Any benefits delivered, issued for
13 delivery or renewed in this Commonwealth by a health insurance
14 policy under section 301 shall not subject an enrollee to
15 separate financial requirements that are applicable only with
16 respect to that coverage.
17    (b)     Cost sharing.--Any cost-sharing requirements imposed by
18 a health insurance policy shall not be more restrictive than the
19 cost-sharing requirements applicable to the health insurance
20 policy's coverage for inpatient physician and surgical services.
21 Section 307.     Access to other providers.
22    (a)     General rule.--Except as provided in subsection (b), a
23 health insurer shall ensure access to at least two distinct
24 providers that are located in this Commonwealth and capable of
25 providing the benefits required under section 301 within their
26 network.
27    (b)     Exception.--
28(1)   Subject to paragraph (2), nothing in subsection (a)
29    shall:
30(i)   Require a health insurer that has a network of
20260SB1360PN1796  - 8 -
1providers to provide benefits covered under section 301
2that are delivered by an out-of-network provider.
3(ii)   Preclude a health insurer that has a network of
4providers from imposing cost-sharing requirements for
5care covered under section 301 that is delivered by an
6out-of-network provider.
7(2)   If a health insurer does not have in its network a
8    provider that can provide care covered under section 301, the
9    health insurer shall cover the care when performed by an out-
10    of-network provider and may not impose cost sharing with
11    respect to the care.
12 Section 308.     Replacements.
13    (a)   Necessity.--A health insurer shall issue payment for the
14 replacement of a prosthetic or custom orthotic device or for the
15 replacement of any part of the device without regard to
16 continuous use or useful lifetime restrictions if a provider
17 determines that the replacement device, or a replacement of part
18 of the device, is necessary because of any of the following:
19(1)   A change in the physiological condition of the
20    enrollee.
21(2)   An irreparable change in the condition of the device
22    or in a part of the device.
23(3)   The condition of the device, or the part of the
24    device, requires repairs and the cost of the repairs would be
25    more than 60% of the cost of a replacement device or of the
26    part being replaced.
27    (b)   Determination and prescription.--A health insurer may
28 require a physician, podiatrist, certified registered nurse
29 practitioner or physician assistant to confirm a determination
30 made by the provider under subsection (a) and issue a
20260SB1360PN1796  - 9 -
1 prescription in accordance with section 13.5(c) of the Medical
2 Practice Act if the prosthetic or custom orthotic device or part
3 being replaced is less than three years old.
4 Section 309.    Notice by Insurance Department.
5    (a)   Development of notice.--The Insurance Department shall
6 develop a notice that includes all of the following:
7(1)   A summary of the new duties and requirements imposed
8    on health insurers and health insurance policies by this act
9    and the dates by which the new duties and requirements take
10    effect.
11(2)   An estimated timeline of any temporary or permanent
12    rules and regulations that the department may issue,
13    promulgate or adopt as authorized under section 311.
14(3)   Any information or guidance not included in
15    paragraph (1) or (2) that is necessary for a health insurer
16    to comply with the provisions of this act.
17    (b)   Posting and distribution of notice.--With respect to the
18 notice under subsection (a), no later than 30 days after the
19 effective date of this subsection, the Insurance Department
20 shall:
21(1)   Post the notice on its publicly accessible Internet
22    website.
23(2)   Provide the notice to all health insurers subject to
24    this act.
25 Section 310.    Reports.
26    (a)   Annual reports required.--No later than January 1, 2028,
27 and each January 1 thereafter, each health insurer subject to
28 this chapter shall report to the Insurance Department on its
29 experience in accordance with the requirements of this act for
30 the previous year.
20260SB1360PN1796  - 10 -
1    (b)   Contents.--Each report under subsection (a) must be in a
2 form developed by the Insurance Department and must include the
3 total number of claims and the total amount of claims paid in
4 this Commonwealth for the services required by this act.
5    (c)   Aggregation of data.--No later than April 1, 2028, and
6 each April 1 thereafter, the Insurance Department shall
7 aggregate the data under subsection (b) for the previous year
8 into an annual report and shall:
9(1)   Submit the report to the Legislative Reference
10    Bureau for publication in the next available issue of the
11    Pennsylvania Bulletin.
12(2)   Post the report on the publicly accessible Internet
13    website of the Insurance Department.
14 Section 311.     Rules and regulations.
15    (a)   Authorization.--The Insurance Department may promulgate
16 or adopt rules and regulations as may be necessary and
17 appropriate to carry out the provisions of this act.
18    (b)   Temporary regulations.--
19(1)   To facilitate the prompt implementation of this act,
20    the Insurance Department may issue temporary regulations. The
21    following shall apply to temporary regulations:
22(i)    The Insurance Department must issue the
23temporary regulations within six months of the effective
24date of this subparagraph. Regulations adopted after this
25six-month period shall be promulgated as provided by
26statute.
27(ii)    Notice of the temporary regulations shall be
28transmitted to the Legislative Reference Bureau for
29publication in the next available issue of the
30Pennsylvania Bulletin.
20260SB1360PN1796  - 11 -
1(iii)    The Insurance Department shall post its
2temporary regulations on its publicly accessible Internet
3website.
4(iv)    The temporary regulations shall expire no later
5than two years following publication of the temporary
6regulations in the Pennsylvania Bulletin.
7(2)   The temporary regulations under paragraph (1) shall
8    be exempt from the following:
9(i)    Section 612 of the act of April 9, 1929
10(P.L.177, No.175), known as The Administrative Code of
111929.
12(ii)    Sections 201, 202, 203, 204 and 205 of the act
13of July 31, 1968 (P.L.769, No.240), referred to as the
14Commonwealth Documents Law.
15(iii)    Sections 204(b) and 301(10) of the act of
16October 15, 1980 (P.L.950, No.164), known as the
17Commonwealth Attorneys Act.
18(iv)    The act of June 25, 1982 (P.L.633, No.181),
19known as the Regulatory Review Act.
20    (c)   Permanent regulations.--Prior to the expiration of the
21 temporary regulations, the Insurance Department shall propose
22 for approval permanent regulations as provided by statute.
23 Section 312.     Enforcement.
24    The Insurance Department shall enforce the provisions of this
25 chapter for health insurers in accordance with the act of July
26 22, 1974 (P.L.589, No.205), known as the Unfair Insurance
27 Practices Act.
28CHAPTER 5
29GOVERNMENT PROGRAMS
30 Section 501.     Coverage for prostheses and orthoses.
20260SB1360PN1796  - 12 -
1    (a)   Amount of coverage.--MA and CHIP managed care plans
2 providing coverage for hospital, medical or surgical expenses
3 must include coverage for prosthetic and custom orthotic
4 devices, services, materials and components as described in this
5 act that:
6(1)   Equals the coverage and payment provided under
7    Federal laws and regulations for the aged and people with
8    disabilities in accordance with:
9(i)    42 U.S.C. §§ 1395k (relating to scope of
10benefits; definitions), 1395l (relating to payment of
11benefits) and 1395m (relating to special payment rules
12for particular items and services).
13(ii)    42 CFR 410.100 (relating to included services),
14414.202 (relating to definitions), 414.210 (relating to
15general payment rules) and 414.228 (relating to
16prosthetic and orthotic devices).
17(2)   Equals payment at a rate not less than the current
18    quarter's Medicare fee schedule for prosthetic and orthotic
19    items and services in this Commonwealth.
20    (b)   Update.--The department shall update the medical
21 assistance fee-for-service program to include all codes for
22 prosthetic and custom orthotic devices and services listed in
23 the current quarter's Medicare fee schedule.
24    (c)   Multiple prostheses and orthoses.--Subject to section
25 503, benefits under this section shall provide coverage for more
26 than one prosthetic or custom orthotic device when medically
27 necessary and shall include coverage for:
28(1)   A prosthetic or custom orthotic device determined by
29    the enrollee's provider to be the most appropriate model that
30    adequately meets the medical needs of the enrollee to restore
20260SB1360PN1796  - 13 -
1    or maintain the ability to perform activities of daily living
2    and essential job-related functions.
3(2)     In addition to coverage described in paragraph (1),
4    a prosthetic or custom orthotic device determined by the
5    enrollee's provider to be the most appropriate model that
6    meets the medical needs of the enrollee for the purposes of:
7(i)    performing physical activities, including
8running, biking, swimming and strength training, as
9applicable; and
10(ii)    maximizing whole-body health, including lower
11and upper limb function, as applicable.
12(3)     In addition to coverage described in paragraphs (1)
13    and (2), a prosthetic or custom orthotic device determined by
14    the enrollee's provider to be the most appropriate model that
15    meets the medical needs of the enrollee for purposes of
16    showering or bathing.
17(4)     All materials and components necessary for use of a
18    prosthetic or custom orthotic device described in paragraphs
19    (1), (2) and (3).
20(5)     Instruction to the enrollee on the use of a
21    prosthetic or custom orthotic device described in paragraphs
22    (1), (2) and (3).
23(6)     The medically necessary repair or replacement of a
24    prosthetic or custom orthotic device described in paragraphs
25    (1), (2) and (3).
26 Section 502.    Nature of benefits.
27    Any benefits delivered, issued for delivery or renewed in
28 this Commonwealth by an MA and CHIP managed care plan under
29 section 501:
30(1)     Shall also be considered rehabilitative and
20260SB1360PN1796  - 14 -
1    habilitative services and devices in accordance with 42
2    U.S.C. § 18022(b) (relating to essential health benefits
3    requirements).
4(2)     Shall not constitute an addition to the State's
5    essential health benefits that requires defrayal of costs by
6    the State in accordance with 42 U.S.C. § 18031(d)(3)(B)
7    (relating to affordable choices of health benefit plans).
8 Section 503.    Determination and prescription.
9    For covered benefits under section 501(c)(2) or (3), the
10 physician, podiatrist, certified registered nurse practitioner
11 or physician assistant of the enrollee shall:
12(1)     Determine that, as applicable, the additional
13    prosthetic or custom orthotic device is necessary to meet the
14    medical needs of the enrollee to:
15(i)    perform physical activities or maximize whole-
16body health, as specified in section 501(c)(2); or
17(ii)   shower or bathe, as specified in section 501(c)
18(3).
19(2)     Issue a prescription for the additional prosthetic
20    or custom orthotic device in accordance with section 13.5(c)
21    of the Medical Practice Act.
22 Section 504.    Nondiscriminatory manner.
23    An MA and CHIP managed care plan:
24(1)     Shall render utilization review determinations in a
25    nondiscriminatory manner.
26(2)     May not deny coverage for prosthetic or custom
27    orthotic devices solely on the basis of an enrollee's actual
28    or perceived disability.
29(3)     May not deny a prosthetic or orthotic benefit for an
30    enrollee with limb loss or absence that would otherwise be
20260SB1360PN1796  - 15 -
1    covered for a person without a disability seeking medical or
2    surgical intervention to restore or maintain the ability to
3    perform the same physical activity.
4 Section 505.   Notification.
5    (a)   Provision.--An MA and CHIP managed care plan shall
6 supply each enrollee annually and, upon written request, each
7 enrollee or health care provider with the following written
8 notification of the benefits specified under section 501 and the
9 rights specified under section 504. The information shall be
10 easily understandable by the layperson.
11    (b)   Adverse benefit determination.--Following an adverse
12 benefit determination based on medical necessity and prior to
13 any appeal of an adverse benefit determination, an MA and CHIP
14 managed care plan shall provide an enrollee or enrollee's
15 authorized representative with a denial in writing. The denial
16 shall include clear reasoning and descriptions as to why the
17 standard of medical necessity has not been met.
18 Section 506.   Financial requirements.
19    (a)   Prohibition.--Any benefits delivered, issued for
20 delivery or renewed in this Commonwealth by an MA and CHIP
21 managed care plan under section 501 shall not subject an
22 enrollee to separate financial requirements that are applicable
23 only with respect to that coverage.
24    (b)   Cost sharing.--Any cost-sharing requirements imposed by
25 an MA and CHIP managed care plan shall not be more restrictive
26 than the cost-sharing requirements applicable to the MA and CHIP
27 managed care plan's coverage for inpatient physician and
28 surgical services.
29 Section 507.   Access to other providers.
30    (a)   General rule.--Except as provided in subsection (b), an
20260SB1360PN1796  - 16 -
1 MA and CHIP managed care plan shall ensure access to at least
2 two distinct providers that are located in this Commonwealth and
3 capable of providing the benefits required under section 501
4 within their network.
5    (b)   Exception.--
6(1)   (i)     Subject to paragraph (2), nothing in subsection
7(a) shall:
8(A)   Require an MA and CHIP managed care plan
9that has a network of providers to provide benefits
10covered under section 501 that are delivered by an
11out-of-network provider.
12(B)   Preclude an MA and CHIP managed care plan
13that has a network of providers from imposing cost-
14sharing requirements for care covered under section
15501 that is delivered by an out-of-network provider.
16(ii)    If an MA and CHIP managed care plan does not
17have in its network a provider that can provide care
18covered under section 501, the MA and CHIP managed care
19plan shall cover the care when performed by an out-of-
20network provider and may not impose cost sharing with
21respect to the care.
22(2)   Nothing in this section shall be construed as
23    limiting an enrollee's ability to receive care under section
24    501 from a health care provider in accordance with 42 CFR
25    431.51 (relating to free choice of providers).
26 Section 508.     Replacements.
27    (a)   Necessity.--An MA and CHIP managed care plan shall issue
28 payment for the replacement of a prosthetic or custom orthotic
29 device or for the replacement of any part of the device without
30 regard to continuous use or useful lifetime restrictions if a
20260SB1360PN1796  - 17 -
1 provider determines that the replacement device, or a
2 replacement of part of the device, is necessary because of any
3 of the following:
4(1)   A change in the physiological condition of the
5    enrollee.
6(2)   An irreparable change in the condition of the device
7    or in a part of the device.
8(3)   The condition of the device, or the part of the
9    device, requires repairs and the cost of the repairs would be
10    more than 60% of the cost of a replacement device or of the
11    part being replaced.
12    (b)   Determination and prescription.--An MA and CHIP managed
13 care plan may require a physician, podiatrist, certified
14 registered nurse practitioner or physician assistant to confirm
15 a determination made by the provider under subsection (a) and
16 issue a prescription in accordance with section 13.5(c) of the
17 Medical Practice Act if the prosthetic or custom orthotic device
18 or part being replaced is less than three years old.
19 Section 509.    Notice by department.
20    (a)   Development of notice.--The department shall develop a
21 notice that includes all of the following:
22(1)   A summary of the new duties and requirements imposed
23    on an MA or CHIP managed care plan by this act and the dates
24    by which the new duties and requirements take effect.
25(2)   An estimated timeline of any temporary or permanent
26    rules and regulations that the department may issue,
27    promulgate or adopt as authorized under section 511.
28(3)   Any information or guidance not included in
29    paragraph (1) or (2) that is necessary for an MA or CHIP
30    managed care plan or any other organization subject to the
20260SB1360PN1796  - 18 -
1    department's enforcement authority under this act to comply
2    with the provisions of this act.
3    (b)   Posting and distribution of notice.--With respect to the
4 notice under subsection (a), no later than 30 days after the
5 effective date of this subsection, the department shall:
6(1)   Post the notice on its publicly accessible Internet
7    website.
8(2)   Provide the notice to each MA or CHIP managed care
9    plan that is a party to a managed care contract with the
10    department and any other organizations subject to the
11    department's enforcement authority under this act.
12 Section 510.    Reports.
13    (a)   Annual reports required.--No later than January 1, 2028,
14 and each January 1 thereafter, each MA or CHIP managed care plan
15 subject to this act shall report to the department on its
16 experience in accordance with the requirements of this act for
17 the previous year.
18    (b)   Contents.--Each report under subsection (a) must be in a
19 form developed by the department and must include the total
20 number of claims and the total amount of claims paid in this
21 Commonwealth for the services required by this act.
22    (c)   Aggregation of data.--No later than April 1, 2028, and
23 each April 1 thereafter, the department shall aggregate the data
24 under subsection (b) for the previous year into an annual report
25 and shall:
26(1)   Submit the report to the Legislative Reference
27    Bureau for publication in the next available issue of the
28    Pennsylvania Bulletin.
29(2)   Post the report on the publicly accessible Internet
30    website of the department.
20260SB1360PN1796  - 19 -
1 Section 511.     Rules and regulations.
2    (a)   Authorization.--The department may promulgate or adopt
3 rules and regulations as may be necessary and appropriate to
4 carry out the provisions of this act.
5    (b)   Temporary regulations.--
6(1)   To facilitate the prompt implementation of this act,
7    the department may issue temporary regulations. The following
8    shall apply to temporary regulations:
9(i)    The department must issue the temporary
10regulations within six months of the effective date of
11this subsection. Regulations adopted after this six-month
12period shall be promulgated as provided by statute.
13(ii)    Notice of the temporary regulations shall be
14transmitted to the Legislative Reference Bureau for
15publication in the next available issue of the
16Pennsylvania Bulletin.
17(iii)    The department shall post its temporary
18regulations on its publicly accessible Internet website.
19(iv)    The temporary regulations shall expire no later
20than two years following publication of the temporary
21regulations in the Pennsylvania Bulletin.
22(2)   The temporary regulations under paragraph (1) shall
23    be exempt from the following:
24(i)    Section 612 of the act of April 9, 1929
25(P.L.177, No.175), known as The Administrative Code of
261929.
27(ii)    Sections 201, 202, 203, 204 and 205 of the act
28of July 31, 1968 (P.L.769, No.240), referred to as the
29Commonwealth Documents Law.
30(iii)    Sections 204(b) and 301(10) of the act of
20260SB1360PN1796  - 20 -
1October 15, 1980 (P.L.950, No.164), known as the
2Commonwealth Attorneys Act.
3(iv)   The act of June 25, 1982 (P.L.633, No.181),
4known as the Regulatory Review Act.
5    (c)    Permanent regulations.--Prior to the expiration of the
6 temporary regulations, the department shall propose for approval
7 permanent regulations as provided by statute.
8 Section 512.      Enforcement.
9    The department shall enforce this act by:
10(1)   Following the complaint procedures under 55 Pa. Code
11    § 107.4(c) (relating to procedures to assure
12    nondiscrimination of participating agencies, institutions,
13    organizations and vendors) for complaints arising under this
14    act.
15(2)   Ensuring that providers receiving medical assistance
16    payments are not engaged in activities prohibited by 55 Pa.
17    Code § 1101.75 (relating to provider prohibited acts).
18CHAPTER 7
19MISCELLANEOUS PROVISIONS
20 Section 701.      Construction.
21    Nothing in this act shall be construed to:
22(1)   Limit benefits otherwise available to an enrollee
23    under a health insurance policy or MA or CHIP managed care
24    plan.
25(2)   Supersede the provisions of the Medical Practice Act
26    or section 443.6 of the act of June 13, 1967 (P.L.31, No.21),
27    known as the Human Services Code.
28 Section 702.      Applicability.
29    This act shall apply as follows:
30(1)   For health insurance policies for which either rates
20260SB1360PN1796  - 21 -
1    or forms are required to be filed with the Federal Government
2    or the Insurance Department, this act shall apply to any
3    policy for which a form or rate is first filed on or after
4    the effective date of this section.
5(2)     For health insurance policies for which neither
6    rates nor forms are required to be filed with the Federal
7    Government or the Insurance Department, this act shall apply
8    to any policy issued or renewed on or after the effective
9    date of this section.
10 Section 703.    Effective date.
11    This act shall take effect in 60 days.
20260SB1360PN1796  - 22 -