HB 1848 — 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
 1   Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
 2      act relating to insurance; amending, revising, and
 3      consolidating the law providing for the incorporation of
 4      insurance companies, and the regulation, supervision, and
 5      protection of home and foreign insurance companies, Lloyds
 6      associations, reciprocal and inter-insurance exchanges, and
 7      fire insurance rating bureaus, and the regulation and
 8      supervision of insurance carried by such companies,
 9      associations, and exchanges, including insurance carried by
10      the State Workmen's Insurance Fund; providing penalties; and
11      repealing existing laws," in casualty insurance, providing
12      for coverage for physical therapy, occupational therapy and
13      speech therapy; and establishing the Children's Therapies
14      Medical Assistance Savings Account.
15      The General Assembly of the Commonwealth of Pennsylvania
16   hereby enacts as follows:
17      Section 1.    The act of May 17, 1921 (P.L.682, No.284), known
18   as The Insurance Company Law of 1921, is amended by adding a
19   section to read:
20      Section 635.11.    Coverage for Physical Therapy, Occupational
21   Therapy and Speech Therapy.--(a)   A health insurance policy or
22   government program shall provide coverage for medically
23   necessary physical therapy, occupational therapy and speech
 1   therapy for covered individuals under twenty-one (21) years of
 2   age. The following shall apply:
 3      (1)     Coverage provided under this section may not be subject
 4   to any deductible, maximum benefit amount or limit on the number
 5   of visits.
 6      (2)     Coverage provided under this section may be subject to
 7   copayments or coinsurance requirements imposed by a health
 8   insurance policy or government program for similar coverage
 9   under the same health insurance policy.
10      (3)     This section shall not be construed as limiting benefits
11   which are otherwise available to an individual under a health
12   insurance policy or government program.
13      (4)     This section shall not be construed as requiring
14   coverage by an insurer of any service based solely on its
15   inclusion in an individualized education program. Consistent
16   with Federal or State law and upon consent of the parent or
17   guardian of the covered individual, the physical, occupational
18   or speech therapies available under this section may be
19   coordinated with any service included in an individualized
20   education program. Coverage of physical, occupational or speech
21   therapies shall not be contingent upon a coordination of
22   services with an individualized education program.
23      (b)     (1)   A restricted account is established within the
24   General Fund to be known as the Children's Therapies Medical
25   Assistance Savings Account.
26      (2)     Savings realized by the medical assistance program, as
27   determined under subsection (c), shall be deposited into the
28   account.
29      (3)     Money in the account is appropriated to the Department
30   of Human Services on a continuing basis to increase access to

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 1   physical therapy, occupational therapy and speech therapy
 2   services for individuals in the Early Intervention Program or
 3   for individuals under twenty-one (21) years of age covered under
 4   a government program.
 5      (4)   Money in the account shall be used by the department to
 6   increase reimbursement rates paid to providers of physical
 7   therapy, occupational therapy and speech therapy or to offset
 8   increased costs in the Children's Health Insurance Program due
 9   to expanded coverage required under subsection (a).
10      (c)   (1)   The Department of Human Services shall, as
11   necessary, develop a formula for calculating savings realized by
12   the medical assistance program due to a decrease in the
13   capitation rate paid to a managed care organization for physical
14   therapy, occupational therapy and speech therapy services for
15   children under twenty-one (21) years of age. The formula shall
16   use the capitation rate from the calendar year prior to when the
17   rates submitted to the Centers for Medicare and Medicaid
18   Services would take effect and subtract the new capitation rate
19   after the rates submitted to the Centers for Medicare and
20   Medicaid Services take effect to calculate the savings.
21      (2)   The sum under paragraph (1) shall be multiplied by the
22   applicable State-share percentage to calculate the total amount
23   of money to be deposited into the account under subsection (b)
24   (2).
25      (d)   As used in this section:
26      (1)   "Account" means the Children's Therapies Medical
27   Assistance Savings Account established under subsection (b)(1).
28      (2)   "Government program" means any of the following:
29      (i)   The medical assistance program established under the act
30   of June 13, 1967 (P.L.31, No.21), known as the "Human Services

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 1   Code."
 2      (ii)     The Children's Health Care Program established under
 3   Article XXIII-A.
 4      (3)     "Health insurance policy" means an individual or group
 5   insurance policy, subscriber contract, certificate or plan
 6   issued by an insurer that provides medical or health care
 7   coverage, including emergency services. The term does not
 8   include:
 9      (i)     An accident only policy.
10      (ii)     A credit only policy.
11      (iii)     A long-term care or disability income policy.
12      (iv)     A specified disease policy.
13      (v)     A Medicare supplement policy.
14      (vi)     A TRICARE policy, including a Civilian Health and
15   Medical Program of the Uniformed Services (CHAMPUS) supplement
16   policy.
17      (vii)     A fixed indemnity policy.
18      (viii)     A hospital indemnity policy.
19      (ix)     A dental only policy.
20      (x)     A vision only policy.
21      (xi)     A workers' compensation policy.
22      (xii)     An automobile medical payment policy.
23      (xiii)     A homeowners' insurance policy.
24      (xiv)     A short-term limited duration policy.
25      (xv)     Any other similar policy providing for limited
26   benefits.
27      (4)     "Insurer" means an entity licensed by the department
28   with accident and health authority to issue a health insurance
29   policy that is offered or governed under any of the following:
30      (i)     This act, including section 630 and Article XXIV.

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 1      (ii)    The act of December 29, 1972 (P.L.1701, No.364), known
 2   as the "Health Maintenance Organization Act."
 3      (iii)    40 Pa.C.S. Ch. 61 (relating to hospital plan
 4   corporations) or 63 (relating to professional health services
 5   plan corporations).
 6      (5)    "Medically necessary" means a service, item, procedure
 7   or level of care that:
 8      (i)    will, or is reasonably expected to, prevent the onset of
 9   an illness, condition, injury or disability;
10      (ii)    will, or is reasonably expected to, reduce or
11   ameliorate the physical, mental or developmental effects of an
12   illness, condition, injury or disability; or
13      (iii)    will assist the recipient to achieve or maintain
14   maximum functional capacity in performing daily activities,
15   taking into account both the functional capacity of the
16   recipient and the functional capacities that are appropriate of
17   recipients of the same age.
18      (6)    "Occupational therapy" means as defined in section 3 of
19   the act of June 15, 1982 (P.L.502, No.140), known as the
20   "Occupational Therapy Practice Act."
21      (7)    "Physical therapy" means as defined in section 2 of the
22   act of October 10, 1975 (P.L.383, No.110), known as the
23   "Physical Therapy Practice Act."
24      (8)    "Speech therapy" means the therapeutic care provided to
25   an individual for treatment administered by a licensed speech-
26   language pathologist.
27      Section 2.     This act shall apply as follows:
28             (1)   For health insurance policies for which either rates
29      or forms are required to be filed with the Insurance
30      Department, the addition of section 635.11 of the act shall

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1     apply to health insurance policies for which a form or rate
2     is first filed on or after the effective date of this
3     paragraph.
4         (2)   For health insurance policies for which neither
5     rates nor forms are required to be filed with the Insurance
6     Department, the addition of section 635.11 of the act shall
7     apply to health insurance policies issued or renewed on or
8     after 180 days after the effective date of this paragraph.
9     Section 3.    This act shall take effect in 90 days.




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