An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, further providing for enrollment limitation.

PRINTER'S NO. 1776
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1371
Session of
2026
INTRODUCED BY KEEFER, JUNE 5, 2026
REFERRED TO HEALTH AND HUMAN SERVICES, JUNE 5, 2026
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,
further providing for enrollment limitation.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 458 of the act of June 13, 1967 (P.L.31,
No.21), known as the Human Services Code, is amended to read:
Section 458. Enrollment Limitation.--[Upon] (a) Except as
provided under subsection (b), upon enrollment in a managed care
plan, an eligible person who retains eligibility shall maintain
enrollment in the managed care plan for not less than twelve
months unless a waiver is granted by the department.
(b) An eligible person may change managed care plans:
(1) without cause during the ninety-day period following the
later of:
(i) the date of the eligible person's initial enrollment; or
(ii) the date that the department sends the eligible person
notice of enrollment;
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(2) without cause during an annual enrollment opportunity,
for which the department shall provide notice at least sixty
days in advance; or
(3) for good cause at any time.
(c) Good cause under subsection (b)(3) shall be limited to
the following causes for disenrollment:
(1) The enrollee moves out of the service area.
(2) The plan does not, because of moral or religious
objections, cover the service that the enrollee seeks.
(3) The enrollee needs related services to be performed at
the same time, not all related services are available within the
provider network and the enrollee's primary care provider or
another provider determines that receiving the services
separately would subject the enrollee to unnecessary risk.
(4) For an enrollee that uses managed long-term services and
supports, the enrollee would have to change the enrollee's
residential, institutional or employment supports provider based
on the provider's change in status from an in-network to an out-
of-network provider and would experience a disruption in the
enrollee's residence or employment.
(5) Other reasons, including poor quality of care, lack of
access to services covered under the contract or lack of access
to providers experienced in dealing with the enrollee's care
needs.
(d) A determination of good cause shall be supported by
documentation or other information sufficient for the department
to validate the basis for the request. A request may not be
approved solely on the basis of a general preference for another
managed care plan, dissatisfaction unsupported by facts specific
to the eligible person, self-attestation without supporting
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information or a general allegation regarding the managed care
plan.
(e) For purposes of subsection (c)(5), a request based on
poor quality of care shall be supported by objective information
substantiating a circumstance affecting the eligible person's
health, safety, access to covered services, continuity of care
or ability to receive medically necessary services. The
department shall consider substantiated complaints, grievance or
appeal determinations, critical incident reports, missed service
records, service plan or authorization records, provider
documentation, care management records, external quality review
findings, corrective action plans, sanctions, quality measure
performance, Consumer Assessment of Healthcare Providers and
Systems results, Healthcare Effectiveness Data and Information
Set measures, National Committee for Quality Assurance
accreditation or ratings, Medicaid and CHIP Quality Rating
System measures or other reliable information identified by the
department. A request based on poor quality of care may not be
approved solely on the basis of an unsupported assertion,
general dissatisfaction or preference for another managed care
plan.
(f) Nothing in this section shall be construed to permit a
general or categorical waiver of subsection (a) permitting
eligible persons to change managed care plans at any time
without cause unless required by Federal law or approved by
statute.
(g) The department shall establish procedures for notice,
review and appeal of a denial of a plan-change request under
this section.
(h) The secretary shall seek any amendment, modification,
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renewal or approval of a waiver authorized under section 1915(b)
of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396n(b))
or other Federal authority necessary to implement this section,
including any amendment, modification, renewal or approval
necessary to establish an enrollment limitation, annual plan
selection period and good cause transfer process consistent with
42 CFR 438.56 (relating to disenrollment: requirements and
limitations). The department shall implement this section to the
fullest extent permitted under Federal law and shall condition
implementation of any provision requiring Federal approval upon
receipt of the necessary approval.
Section 2. This act shall take effect in 60 days.
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