HB 1721 — 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
 1   Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
 2      act to consolidate, editorially revise, and codify the public
 3      welfare laws of the Commonwealth," in public assistance,
 4      providing for medical assistance coverage for peer recovery
 5      support services.
 6      The General Assembly of the Commonwealth of Pennsylvania
 7   hereby enacts as follows:
 8      Section 1.    The act of June 13, 1967 (P.L.31, No.21), known
 9   as the Human Services Code, is amended by adding a section to
10   read:
11      Section 443.16.    Medical Assistance Coverage for Peer
12   Recovery Support Services.--(a)   Peer recovery support services
13   are compensable under the medical assistance program in
14   accordance with the Commonwealth's approved State plan for
15   individuals with a mental health disorder or substance use
16   disorder through a licensed provider or through a certified peer
17   recovery support services provider. Peer recovery support
18   services are reimbursable as a primary service for individuals
19   with a mild, moderate or severe mental health disorder or
 1   substance use disorder and as a primary service for family
 2   members of a covered medical assistance beneficiary and require
 3   no other diagnosis, condition or preauthorization.
 4      (b)   Peer recovery support services delivered by a provider
 5   shall be deemed eligible for reimbursement under subsection (a)
 6   if supervised by a licensed mental health practitioner, which
 7   shall include an appropriately trained and credentialed peer
 8   support specialist supervisor.
 9      (c)   The department and the Department of Drug and Alcohol
10   Programs shall promulgate regulations as necessary to implement
11   this section. The department and the Department of Drug and
12   Alcohol Programs shall ensure that the regulations promulgated
13   under this subsection comply with all of the following criteria:
14      (1)   The regulations may not interrupt the provision of care
15   to recipients enrolled in the medical assistance program.
16      (2)   The regulations shall provide a reasonable amount of
17   time for an existing provider participating in the medical
18   assistance program on the effective date of this paragraph to
19   comply with the provisions of this section while continuing to
20   participate in the medical assistance program.
21      (3)   The regulations may not require a peer recovery support
22   services provider to seek certification as a certified peer
23   recovery support services provider if the provider does not seek
24   reimbursement through the medical assistance program.
25      (4)   The regulations shall provide a reasonable mechanism for
26   the establishment of medical necessity for a recipient of peer
27   recovery support services by a certified peer recovery support
28   services provider that authorizes the provider to contract
29   directly with an external licensed mental health practitioner
30   for a proposed recipient assessment and referral.

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 1      (5)    The regulations shall provide for the certification of a
 2   peer recovery support services provider by the department or the
 3   Department of Drug and Alcohol Programs that provides peer
 4   recovery support services to individuals, family members and
 5   loved ones for mental health, substance use or both mental
 6   health and substance use. The regulations shall include all the
 7   following requirements for a peer recovery support services
 8   provider applying for certification by the department or the
 9   Department of Drug and Alcohol Programs:
10      (i)    The applicant shall be a nonclinical provider that
11   employs peer recovery support specialists to provide peer
12   recovery support services.
13      (ii)    The applicant shall employ peer support specialist
14   supervisors and provide at least weekly peer support specialist
15   supervision to each employed peer recovery support specialist.
16      (iii)   The applicant shall annually attest under penalty of
17   perjury that the applicant is governed by a nonprofit board of
18   directors comprised of at least 51% membership from individuals,
19   family members or loved ones with a lived or living experience
20   involving a mental health or substance use disorder.
21      (iv)    The applicant shall have policies and procedures to
22   ensure compliance in providing support for all pathways and
23   programs of individual recovery, including harm reduction,
24   abstinence and medication use.
25      (6)    The department shall supervise and facilitate the
26   certification of a peer recovery support services provider for
27   mental health.
28      (7)    The Department of Drug and Alcohol Programs shall
29   supervise and facilitate the certification of a peer recovery
30   support services provider for substance use.

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 1      (8)   The department and the Department of Drug and Alcohol
 2   Programs shall supervise and facilitate the certification of a
 3   peer recovery support services provider for both mental health
 4   and substance use through a joint certification by the
 5   department and the Department of Drug and Alcohol Programs.
 6      (d)   Nothing in this section shall be construed to impede,
 7   disallow or modify the conditions of an existing clinically or
 8   medically licensed provider on the effective date of this
 9   subsection that is authorized to provide peer recovery support
10   services to recipients in the medical assistance program.
11      (e)   The following words and phrases when used in this
12   section shall have the meanings given to them in this subsection
13   unless the context clearly indicates otherwise:
14      "Certified peer recovery support services provider."     An
15   independent, nonclinical, nonprofit organization as specified
16   under 26 U.S.C. § 501(c)(3) (relating to exemption from tax on
17   corporations, certain trusts, etc.) that meets all of the
18   following criteria:
19      (1)   Is appropriately credentialed by the department or the
20   Department of Drug and Alcohol Programs.
21      (2)   Is led and governed by individuals in mental health and
22   substance use recovery.
23      (3)   Employs peer recovery support specialists and peer
24   support specialist supervisors.
25      (4)   Provides peer recovery support services.
26      "Mental health disorder."   A concern characterized by a
27   significant disturbance in an individual's cognition, emotional
28   regulation or behavior that reflects a dysfunction in the
29   psychological, biological or development processes underlying
30   mental functioning.

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 1      "Peer recovery support services."   A form of nonprofessional,
 2   nonclinical assistance provided by a peer recovery support
 3   specialist that is delivered in-person, via video or telephone
 4   or virtually, to an individual, family member or loved one as a
 5   means to support the recovery from a mental health or substance
 6   use disorder, including a direct one-on-one engagement or direct
 7   group engagement with a maximum of ten individuals per peer
 8   recovery support specialist.
 9      "Peer recovery support specialist."   An individual who has a
10   personal lived or living experience involving a mental health or
11   substance use disorder, including with a family member or loved
12   one, and who has been trained and certified in this Commonwealth
13   by an approved training and certifying body.
14      "Peer support specialist supervisor."   An individual who has
15   a personal lived or living experience involving a mental health
16   or substance use disorder, including with a family member or
17   loved one, and who has been trained and certified in this
18   Commonwealth by an approved training and certifying body with a
19   valid peer support specialist supervisor credential of any type.
20   The term does not include an individual with an active clinical
21   or medical license.
22      "Substance use disorder."   A pattern of use of alcohol or
23   other drugs leading to clinical or functional impairment.
24      Section 2.   This act shall take effect in 90 days.




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