Pennsylvania 2025-2026 Regular Session

Pennsylvania House Bill HB2164

Introduced
1/28/26  

Caption

In public assistance, providing for medical assistance for complex care assistant services.

Summary

HB2164 would create a new Medical Assistance program for “complex care assistant services” for certain Medicaid recipients, primarily children under age 21 and individuals eligible for private duty nursing. Under the bill, a family member could be certified as a complex care assistant and, while working under the direction of a registered nurse through a home health agency, provide specified hands-on care to the recipient. The bill frames this as a home health care benefit within Medical Assistance and makes participation optional for both the family and the Medicaid-enrolled home health provider. The bill sets out training, competency, and oversight requirements for family members who become certified, including completion of 75 hours of training and a competency evaluation consistent with federal home health aide standards. It also requires periodic registered nurse home visits every 30 days, directs the Department of Human Services to develop an assessment tool, and requires the department to seek any needed federal waiver or state plan amendment. The bill further requires the department to convene an advisory working group, issue regulations, and report to the Governor and General Assembly on the program’s viability within three years of implementation.

Impact

HB2164 would amend the Human Services Code by adding a new section governing Medicaid-funded complex care assistant services. It would authorize reimbursement through home health agencies at a minimum rate of $45 per hour for services provided by certified family members, and it would require the state to pursue federal approval to exclude earnings from this work from countable family income. The bill would also create new administrative duties for the Department of Human Services, including certification standards, assessment criteria, stakeholder consultation, regulatory implementation, and a post-implementation viability report. The affected parties include Medicaid recipients with complex medical needs, their family caregivers, home health agencies, registered nurses, and the state Medicaid program.

Sentiment

The bill appears generally supportive of family caregiving and access to in-home care, with bipartisan sponsorship suggesting broad interest in the concept. Even without recorded committee debate or votes, the structure of the bill indicates a favorable policy posture toward helping medically fragile children and their families receive care at home while being compensated through Medicaid. The inclusion of optional participation for families and providers, plus a required advisory working group, suggests an effort to balance expansion of services with implementation oversight.

Contention

The main points of potential contention are likely to be cost, Medicaid administration, and federal approval. The bill establishes a minimum reimbursement rate and requires the state to seek waivers or plan amendments, which could raise concerns about fiscal impact and whether federal authorities will approve the program. There may also be debate over whether family members should be paid through Medicaid for providing care that is traditionally unpaid, and whether the program could affect home health agency staffing, oversight, or quality-of-care standards. Supporters are likely to be families of medically fragile children and advocacy groups, while concerns may come from budget-minded policymakers, administrators, or providers focused on program complexity and reimbursement obligations.

Companion Bills

No companion bills found.

Previously Filed As

PA SB1041

In public assistance, providing for medical assistance for complex care assistant services.

PA SB860

In public assistance, further providing for reimbursement for certain medical assistance items and services.

PA HB1310

In public assistance, further providing for medical assistance payments for institutional care.

PA HB282

In public assistance, further providing for persons eligible for medical assistance.

PA HB1721

In public assistance, providing for medical assistance coverage for peer recovery support services.

PA SB1316

In public assistance, providing for pending medical assistance applications.

PA HB1345

In public assistance, providing for medical assistance coverage for menopause treatments.

PA HB583

In public assistance, further providing for reimbursement for certain medical assistance items and services; and abrogating regulations.

PA HB298

In public assistance, providing for waivers to be requested for medical assistance.

PA HB399

In public assistance, further providing for administration of assistance programs.

Similar Bills

No similar bills found.