An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for physical therapy, occupational therapy and speech therapy; and establishing the Children's Therapies Medical Assistance Savings Account.

PRINTER'S NO. 2284
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1848
Session of
2025
INTRODUCED BY BOROWSKI, BRENNAN, K.HARRIS, GIRAL, RIVERA,
D. WILLIAMS, SANCHEZ, MARKOSEK, WAXMAN, CERRATO, HOHENSTEIN,
MADDEN, PROBST, HARKINS, SHUSTERMAN, STEELE, CEPEDA-FREYTIZ
AND BOYD, SEPTEMBER 5, 2025
REFERRED TO COMMITTEE ON HUMAN SERVICES, SEPTEMBER 9, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for physical therapy, occupational therapy and
speech therapy; and establishing the Children's Therapies
Medical Assistance Savings Account.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Coverage for Physical Therapy, Occupational
Therapy and Speech Therapy.--(a) A health insurance policy or
government program shall provide coverage for medically
necessary physical therapy, occupational therapy and speech
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therapy for covered individuals under twenty-one (21) years of
age. The following shall apply:
(1) Coverage provided under this section may not be subject
to any deductible, maximum benefit amount or limit on the number
of visits.
(2) Coverage provided under this section may be subject to
copayments or coinsurance requirements imposed by a health
insurance policy or government program for similar coverage
under the same health insurance policy.
(3) This section shall not be construed as limiting benefits
which are otherwise available to an individual under a health
insurance policy or government program.
(4) This section shall not be construed as requiring
coverage by an insurer of any service based solely on its
inclusion in an individualized education program. Consistent
with Federal or State law and upon consent of the parent or
guardian of the covered individual, the physical, occupational
or speech therapies available under this section may be
coordinated with any service included in an individualized
education program. Coverage of physical, occupational or speech
therapies shall not be contingent upon a coordination of
services with an individualized education program.
(b) (1) A restricted account is established within the
General Fund to be known as the Children's Therapies Medical
Assistance Savings Account.
(2) Savings realized by the medical assistance program, as
determined under subsection (c), shall be deposited into the
account.
(3) Money in the account is appropriated to the Department
of Human Services on a continuing basis to increase access to
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physical therapy, occupational therapy and speech therapy
services for individuals in the Early Intervention Program or
for individuals under twenty-one (21) years of age covered under
a government program.
(4) Money in the account shall be used by the department to
increase reimbursement rates paid to providers of physical
therapy, occupational therapy and speech therapy or to offset
increased costs in the Children's Health Insurance Program due
to expanded coverage required under subsection (a).
(c) (1) The Department of Human Services shall, as
necessary, develop a formula for calculating savings realized by
the medical assistance program due to a decrease in the
capitation rate paid to a managed care organization for physical
therapy, occupational therapy and speech therapy services for
children under twenty-one (21) years of age. The formula shall
use the capitation rate from the calendar year prior to when the
rates submitted to the Centers for Medicare and Medicaid
Services would take effect and subtract the new capitation rate
after the rates submitted to the Centers for Medicare and
Medicaid Services take effect to calculate the savings.
(2) The sum under paragraph (1) shall be multiplied by the
applicable State-share percentage to calculate the total amount
of money to be deposited into the account under subsection (b)
(2).
(d) As used in this section:
(1) "Account" means the Children's Therapies Medical
Assistance Savings Account established under subsection (b)(1).
(2) "Government program" means any of the following:
(i) The medical assistance program established under the act
of June 13, 1967 (P.L.31, No.21), known as the "Human Services
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Code."
(ii) The Children's Health Care Program established under
Article XXIII-A.
(3) "Health insurance policy" means an individual or group
insurance policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage, including emergency services. The term does not
include:
(i) An accident only policy.
(ii) A credit only policy.
(iii) A long-term care or disability income policy.
(iv) A specified disease policy.
(v) A Medicare supplement policy.
(vi) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS) supplement
policy.
(vii) A fixed indemnity policy.
(viii) A hospital indemnity policy.
(ix) A dental only policy.
(x) A vision only policy.
(xi) A workers' compensation policy.
(xii) An automobile medical payment policy.
(xiii) A homeowners' insurance policy.
(xiv) A short-term limited duration policy.
(xv) Any other similar policy providing for limited
benefits.
(4) "Insurer" means an entity licensed by the department
with accident and health authority to issue a health insurance
policy that is offered or governed under any of the following:
(i) This act, including section 630 and Article XXIV.
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(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(5) "Medically necessary" means a service, item, procedure
or level of care that:
(i) will, or is reasonably expected to, prevent the onset of
an illness, condition, injury or disability;
(ii) will, or is reasonably expected to, reduce or
ameliorate the physical, mental or developmental effects of an
illness, condition, injury or disability; or
(iii) will assist the recipient to achieve or maintain
maximum functional capacity in performing daily activities,
taking into account both the functional capacity of the
recipient and the functional capacities that are appropriate of
recipients of the same age.
(6) "Occupational therapy" means as defined in section 3 of
the act of June 15, 1982 (P.L.502, No.140), known as the
"Occupational Therapy Practice Act."
(7) "Physical therapy" means as defined in section 2 of the
act of October 10, 1975 (P.L.383, No.110), known as the
"Physical Therapy Practice Act."
(8) "Speech therapy" means the therapeutic care provided to
an individual for treatment administered by a licensed speech-
language pathologist.
Section 2. This act shall apply as follows:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Insurance
Department, the addition of section 635.11 of the act shall
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apply to health insurance policies for which a form or rate
is first filed on or after the effective date of this
paragraph.
(2) For health insurance policies for which neither
rates nor forms are required to be filed with the Insurance
Department, the addition of section 635.11 of the act shall
apply to health insurance policies issued or renewed on or
after 180 days after the effective date of this paragraph.
Section 3. This act shall take effect in 90 days.
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