An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for medical assistance coverage for peer recovery support services.

PRINTER'S NO. 2121
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1721
Session of
2025
INTRODUCED BY KHAN, FLICK, GIRAL, BOYD, SMITH-WADE-EL, SANCHEZ,
PROBST, HILL-EVANS, BOROWSKI, FLEMING, CEPEDA-FREYTIZ,
HOHENSTEIN, WAXMAN AND GREEN, JULY 11, 2025
REFERRED TO COMMITTEE ON HUMAN SERVICES, JULY 14, 2025
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
providing for medical assistance coverage for peer recovery
support services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
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
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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.
(b) 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.
(c) The department and the Department of Drug and Alcohol
Programs shall promulgate regulations as necessary to implement
this section. The department and the Department of Drug and
Alcohol Programs shall ensure that the regulations promulgated
under this subsection comply with all of the following criteria:
(1) The regulations may not interrupt the provision of care
to recipients enrolled in the medical assistance program.
(2) The regulations shall provide a reasonable amount of
time for an existing provider participating in the medical
assistance program on the effective date of this paragraph to
comply with the provisions of this section while continuing to
participate in the medical assistance program.
(3) The regulations may not require a peer recovery support
services provider to seek certification as a certified peer
recovery support services provider if the provider does not seek
reimbursement through the medical assistance program.
(4) 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.
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(5) 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. The regulations shall include all the
following requirements for a peer recovery support services
provider applying for certification by the department or the
Department of Drug and Alcohol Programs:
(i) The applicant shall be a nonclinical provider that
employs peer recovery support specialists to provide peer
recovery support services.
(ii) The applicant shall employ peer support specialist
supervisors and provide at least weekly peer support specialist
supervision to each employed peer recovery support specialist.
(iii) The applicant shall annually attest under penalty of
perjury that the applicant is governed by a nonprofit board of
directors comprised of at least 51% membership from individuals,
family members or loved ones with a lived or living experience
involving a mental health or substance use disorder.
(iv) The applicant shall have policies and procedures to
ensure compliance in providing support for all pathways and
programs of individual recovery, including harm reduction,
abstinence and medication use.
(6) The department shall supervise and facilitate the
c ertification of a peer recovery support services provider for
mental health.
(7) The Department of Drug and Alcohol Programs shall
supervise and facilitate the certification of a peer recovery
support services provider for substance use.
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(8) The department and the Department of Drug and Alcohol
Programs shall supervise and facilitate the certification of a
peer recovery support services provider for both mental health
and substance use through a joint certification by the
department and the Department of Drug and Alcohol Programs.
(d) 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.
(e) The following words and phrases when used in this
section shall have the meanings given to them in this subsection
unless the context clearly indicates otherwise:
"Certified peer recovery support services provider." An
independent, nonclinical, nonprofit organization as specified
under 26 U.S.C. § 501(c)(3) (relating to exemption from tax on
corporations, certain trusts, etc.) that meets all of the
following criteria:
(1) Is appropriately credentialed by the department or the
Department of Drug and Alcohol Programs.
(2) Is led and governed by individuals in mental health and
substance use recovery.
(3) Employs peer recovery support specialists and peer
support specialist supervisors.
(4) Provides peer recovery support services.
"Mental health disorder." A concern characterized by a
significant disturbance in an individual's cognition, emotional
regulation or behavior that reflects a dysfunction in the
psychological, biological or development processes underlying
mental functioning.
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"Peer recovery support services." A form of nonprofessional,
nonclinical assistance provided by a peer recovery support
specialist that is delivered in-person, via video or telephone
or virtually, to an individual, family member or loved one as a
means to support the recovery from a mental health or substance
use disorder, including a direct one-on-one engagement or direct
group engagement with a maximum of ten individuals per peer
recovery support specialist.
"Peer recovery support specialist." An individual who has a
personal lived or living experience involving a mental health or
substance use disorder, including with a family member or loved
one, and who has been trained and certified in this Commonwealth
by an approved training and certifying body.
"Peer support specialist supervisor." An individual who has
a personal lived or living experience involving a mental health
or substance use disorder, including with a family member or
loved one, and who has been trained and certified in this
Commonwealth by an approved training and certifying body with a
valid peer support specialist supervisor credential of any type.
The term does not include an individual with an active clinical
or medical license.
"Substance use disorder." A pattern of use of alcohol or
other drugs leading to clinical or functional impairment.
Section 2. This act shall take effect in 90 days.
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