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SB 567

An Act amending Titles 16 (Counties) and 53 (Municipalities Generally) of the Pennsylvania Consolidated Statutes, in fiscal affairs, further providing for operating reserve fund; providing for regular cyclical revision of assessment and for State Tax Equalization Board; and making a repeal.

2025-2026 Regular Session Introduced by Jay Costa and 3 co-sponsors

The bill expands Medicaid SUD care by raising per diem rates, adding coverage for additional residential ASAM levels, and using state funds to leverage federal matching funds to bo

Referred to Local Government
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WeVote Research Nonpartisan
Bill Summary · SB 567

SB 567 — Medicaid SUD Services Rate Adjustment Act

Status: Passed 1st Reading
Introduced: February 20, 2025
Primary sponsors: Senators Meyer, Adcock, and Batch (primary sponsors listed in bill text)

Purpose

To improve Medicaid reimbursement for substance use disorder (SUD) treatment by (1) increasing per‑diem rates for several ASAM (American Society of Addiction Medicine) levels of care, (2) establishing Medicaid coverage for additional residential ASAM levels, and (3) providing General Fund appropriations to support the rate changes and secure federal matching funds. The intent is to strengthen provider viability, expand access to a full continuum of SUD services, and support treatment capacity for Medicaid enrollees.

Key provisions

  • Rate increases (per diem) for covered Medicaid SUD services:
    • ASAM Level 2.1 (intensive outpatient): $255.28
    • ASAM Level 2.5 (comprehensive outpatient): $400.00
    • ASAM Level 3.7 (medically monitored community residential): $650.00
    • ASAM Level 3.7 non‑hospital medical detoxification: $756.65
  • Establishes Medicaid coverage and payment rates for residential ASAM levels not previously covered:
    • ASAM Level 3.1 (clinically managed, low‑intensity residential): $350.00 per diem
    • ASAM Level 3.3 (clinically managed, high‑intensity residential): $250.00 per diem
    • ASAM Level 3.5 (clinically managed residential treatment): $550.00 per diem
  • Appropriation:
    • $15,000,000 in recurring General Fund each year of the 2025–2027 fiscal biennium to the Department of Health and Human Services (DHHS), Division of Health Benefits.
    • Those state dollars are intended to draw and match approximately $27,400,000 in recurring federal Medicaid funds each year (total recurring funding to support the rate changes).
  • Implementation responsibilities:
    • DHHS, Division of Health Benefits, to make the rate adjustments and establish coverage consistent with the bill.
  • Effective date: July 1, 2025 (per bill language).

Who is affected

  • Medicaid beneficiaries with SUD who require outpatient and residential treatment — likely improved access to covered levels of care.
  • SUD treatment providers (intensive outpatient, comprehensive outpatient, residential treatment providers, medically monitored detox programs) — will receive higher reimbursement rates and new coverage for certain residential levels.
  • State budget/health care administrators — DHHS must implement rate changes and manage budget/federal match.

Fiscal and operational impact

  • Direct recurring state cost: $15 million/year (General Fund) for each year of the 2025–2027 biennium; intended to leverage about $27.4 million/year in federal Medicaid matching funds, increasing total recurring resources available for SUD services.
  • Expected outcomes: improved provider reimbursement may enhance provider participation and capacity, potentially improving beneficiary access to a broader continuum of SUD care.
  • Implementation tasks: DHHS must update Medicaid coverage policies, provider rate schedules, claims/payment systems, and communicate changes to providers and managed care entities (if applicable).

Timeline / Procedure

  • Introduced February 20, 2025; passed 1st reading (per provided status).
  • Rate changes and new coverage are set to take effect July 1, 2025, contingent on DHHS rulemaking and operational updates necessary to implement new rates and coverage.

If you want, I can:
- Produce a one‑page summary you can distribute to providers or constituents.
- Draft a short explainer on ASAM levels and what the new coverage means for clinical services.

Compiled from official sources — confirm details with the bill’s official record.

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