Jim Sharp • March 4, 2026
Shapiro Administration Protects Consumers, Fines Aetna $550,000 for Violations of Mental Health Parity Laws
Author
Jim Sharp
Date
March 4, 2026
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Press Release by Pennsylvania Insurance Department (PID): Published March 3, 2026
Excerpt below:
Harrisburg, PA – The Pennsylvania Insurance Department (PID) today announced the results of a market conduct exam on Aetna that found several violations by the health insurance company that negatively impacted policyholders. As a result, the company must pay a $550,000 penalty, fix its practices, and repay affected Pennsylvanians. PID's market conduct exams are one of the most impactful ways the Shapiro Administration prioritizes consumer protection. These exams hold insurance companies accountable and ensure Pennsylvania families receive the coverage they are promised.

By Tim Sohosky
•
May 29, 2026
On Thursday, May 28, the Office of Developmental Programs (ODP) provided an update to the Medical Assistance Advisory Committee (MAAC) regarding current policies and upcoming regulatory changes following a recent Commonwealth Court decision. On February 17, 2026, the PA Commonwealth Court issued a decision in Dunkelberger v. Department of Human Services that determined that ODP’s limitations on provider model services (specifically the 40/60-hour caps and 90-day travel maximums) were null and void. The decision was based on process rather than policy validity; the Court found that these limitations were not properly promulgated as regulations in accordance with the Commonwealth Documents Law and Regulatory Review Act. To maintain a balanced approach between flexibility and oversight, ODP is moving forward with the following actions: Regulatory Amendments: ODP will amend regulations to establish formal authority for setting service delivery limits that support individual welfare and program integrity. Self-Directed Model Agreements: ODP has already modified agreements for self-directed models to clarify limits on overtime, combined relative service provision, and travel restrictions. Travel Restrictions: Due to the inability to monitor services effectively over long distances, service provision will now be limited to Pennsylvania and contiguous states. Waiver Changes: ODP will seek modifications through the amendment process to the Consolidated, P/FDS, Community Living, and Adult Autism Waivers to include: New requirements for agencies providing IHCS and Companion services to disclose a DSP's relationship to participants; and Strengthened programmatic oversight and integrity measures. Life Sharing Alternative: For participants requiring more than 60 hours of paid care from a relative, the Life Sharing (24/7) service model remains the recommended alternative. ODP anticipates a public comment period for these proposed waiver changes beginning in January 2027.

By Cathy Barrick
•
May 28, 2026
The Office of Developmental Programs (ODP) has shared ODPANN 26-039 . The purpose of this communication is to provide updated details about the Residential Performance-Based Contracting (PBC) Pay-for-Performance (P4P) initiatives for Fiscal Year 2026/27. Updates are provided in red . Please review the announcement for more details. Visit here to access the Pay for Performance (P4P): Residential Rural Capacity Expansion Plan template .

