An Act providing for eligibility for State funds; imposing duties on the Department of Human Services; providing for investigations by the Department of Human Services and the Office of Attorney General; and imposing penalties.

PRINTER'S NO. 1675
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1321
Session of
2026
INTRODUCED BY GEBHARD, DUSH, MASTRIANO, HUTCHINSON, STEFANO,
MARTIN, J. WARD, VOGEL AND KEEFER, MAY 1, 2026
REFERRED TO BANKING AND INSURANCE, MAY 1, 2026
AN ACT
Providing for eligibility for State funds; imposing duties on
the Department of Human Services; providing for
investigations by the Department of Human Services and the
Office of Attorney General; and imposing penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Eligibility
for State Funds Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Claim." A request for payment, reimbursement or other
compensation submitted to the department by or on behalf of a
health care facility or health care practitioner under a
government program.
"Covered Federal funding limitation." The limitation on
Federal financial participation for services furnished to
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minors, including the applicable age limits, covered services
and exceptions, under the standards described in 90 Fed. Reg.
242, 59441 (December 19, 2025).
"Department." The Department of Human Services of the
Commonwealth.
"Government program." A program of government-sponsored or
government-subsidized health care coverage, including any of the
following:
(1) The Children's Health Insurance Program under
Article XXIII-A of the act of May 17, 1921 (P.L.682, No.284),
known as The Insurance Company Law of 1921.
(2) The medical assistance program under Subdivision (f)
of Article IV of the act of June 13, 1967 (P.L.31, No.21),
known as the Human Services Code.
"Health care facility." As defined in section 103 of the act
of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Health care practitioner." As defined in section 103 of the
Health Care Facilities Act.
Section 3. Payments by department.
(a) Prohibition.--The department may not issue payment under
a government program for a claim that is subject to the covered
Federal funding limitation.
(b) Investigation.--The department shall investigate a
suspected violation of subsection (a) by a health care facility
or health care practitioner.
(c) Remedies.--If, after an investigation under subsection
(b), the department determines that a health care facility or
health care practitioner knew or should have known that a claim
violated subsection (a), the following shall apply:
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(1) The department may suspend the eligibility of the
health care facility or health care practitioner to
participate in a government program.
(2) The department shall require the health care
facility or health care practitioner to repay to the
Commonwealth an amount equal to not less than two times and
not more than three times the amount billed to the government
program in violation of subsection (a).
(d) Failure to produce records or comply.--A health care
facility or health care practitioner that fails to produce
records or comply with an effort by the department or the Office
of Attorney General to ascertain compliance with this section
commits a violation of this section. The department may suspend
the eligibility of the health care facility or health care
practitioner to participate in a government program for a
violation under this subsection.
Section 4. Administrative review.
An action by the department under section 3 shall be subject
to 2 Pa.C.S. Chs. 5 Subch. A (relating to practice and procedure
of Commonwealth agencies) and 7 Subch. A (relating to judicial
review of Commonwealth agency action).
Section 5. Concurrent jurisdiction.
The Office of Attorney General shall have concurrent
jurisdiction to investigate a suspected violation of section 3.
Section 6. Effective date.
This act shall take effect in 120 days.
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