Senate Bill 1321 Printer's Number 1675

PENNSYLVANIA, May 1 - 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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