Legal text appendix — Healthcare Delivery

The legal chain that produces PA-3's healthcare-delivery architecture, organized constitutional → federal → state → local. The federal substantive layer threads through Medicare Title XVIII, Medicaid Title XIX, the ACA, CMS Conditions of Participation plus ACGME plus IRC § 501(r) plus EMTALA plus HIPAA plus the Hospital Price Transparency Rule, HRSA § 330 plus 340B plus FTCA, MHPAEA plus SAMHSA plus DEA plus 988, plus the 2025-2026 federal-policy-cycle architecture (IRA Medicare Drug Price Negotiation; OBBBA P.L. 119-21; IRA Enhanced Premium Tax Credit expiration; the 340B Rebate Model Pilot litigation; the Title X disruption sequence; the Medicare telehealth post-PHE flexibility extensions; the MHPAEA 2024 Final Rule partial non-enforcement). The state layer threads through PA Insurance Department, PA DHS OMAP, PA DOH licensure, PA OMHSAS, PA Public Welfare Code, PA Health Care Facilities Act, PA Act 42 of 2019 PHIEA / Pennie, PA Act 50 of 2004 Mental Health Parity Act, PA Act 98 of 2022 telehealth permanence, PA Act 54 of 2024 Affordability Program, PA MCARE Act plus 2024 tort reform, and PA medical-debt protections. The Philadelphia layer threads through the Home Rule Charter DBHIDS / CBH single-MCO architecture, Philadelphia Code Title 6, PDPH operations, and the PA-3 anchor hospital institutional architecture at Penn Medicine, Temple Health, Jefferson Health, and CHOP. For the analytical treatment of how each instrument operates and where its gaps fall, see the seven D21 sub-domain pages.

Constitutional foundation

U.S. Constitution

Article I, § 8 — Spending Clause (Cornell LII).
Authorizes federal financial assistance to state and local healthcare-delivery programs. The constitutional basis for Medicare (Title XVIII), Medicaid (Title XIX), CHIP (Title XXI), ACA marketplace and Premium Tax Credit architecture, HRSA Section 330 Health Center Program, 340B Drug Pricing Program, Title X family planning, IIJA, OBBBA, and the entirety of D21's federal-floor architecture. Conditional-spending principles articulated in South Dakota v. Dole, 483 U.S. 203 (1987) govern state-plan submission requirements.
Cited in: every D21 sub-domain.

Article I, § 8 — Commerce Clause (Cornell LII).
Authorizes federal regulation of interstate insurance markets, federal MHPAEA framework, and federal SUD treatment regulatory architecture. The McCarran-Ferguson Act of 1945 (15 U.S.C. § 1011) preserves state insurance regulation; ERISA preempts state regulation of self-funded employer health plans.
Cited in: ACA & Commercial · BH & SUD Delivery.

10th Amendment (Cornell LII).
Reserves state administrative discretion at Medicaid program operations subject to federal conditions; reserves state hospital licensure, healthcare workforce licensure, pharmacy regulation, and SUD treatment licensing authority.
Cited in: every D21 sub-domain.

14th Amendment, § 1 — Equal Protection / Due Process (Cornell LII).
Grounds the civil-rights overlays on federally-funded healthcare programs (Title VI; § 1557 ACA).
Cited in: every D21 sub-domain; particularly Specialty (Title VI healthcare access analysis).

Key foundational cases

NFIB v. Sebelius, 567 U.S. 519 (2012) (Justia).
Preserved state discretion on ACA Medicaid expansion while upholding the ACA individual-market architecture. Pennsylvania accepted Medicaid expansion in 2015.
Cited in: every D21 sub-domain.

King v. Burwell, 576 U.S. 988 (2015) (Justia).
Preserved federal Premium Tax Credits in states using federal HealthCare.gov.
Cited in: ACA & Commercial.

California v. Texas, 593 U.S. 659 (2021) (Justia).
Preserved the ACA when challenged through the individual mandate post-zero-penalty amendment.
Cited in: ACA & Commercial.

Kennedy v. Braidwood Management, Inc., 606 U.S. 748 (June 27, 2025).
Upheld the ACA § 2713 preventive-services mandate nationwide. Cross-reference D2 verified file for substantive analysis.
Cited in: ACA & Commercial.

American Hospital Association et al. v. Kennedy et al., No. 25-cv-600 (D. Me., February 10, 2026).
Vacated and remanded to HHS the 340B Rebate Model Pilot Program Application Notice (90 Fed. Reg. 36,163; August 1, 2025), Corrected Application Notice (90 Fed. Reg. 38,165; August 7, 2025), and manufacturer-application approvals (October 30 - November 14, 2025).
Cited in: FQHC & Safety-Net · Specialty.

ERIC v. DOL/HHS/Treasury, U.S. District Court for the District of Columbia (Judge Timothy J. Kelly).
Filed January 17, 2025 by the ERISA Industry Committee challenging the September 2024 MHPAEA Final Rule. Abeyance granted May 12, 2025; Tri-Agency non-enforcement statement issued May 9-15, 2025 — the agencies will not enforce the 2024 Final Rule's new provisions until ERIC litigation resolves plus 18 months. The 2013 Final Rule plus CAA 2021 statutory NQTL comparative-analysis obligations remain in force.
Cited in: BH & SUD Delivery · ACA & Commercial.

Cornerstone Credit Union League v. CFPB, E.D. Tex. (July 2025).
Vacated the CFPB rule that would have removed all medical debt from credit reports before it took effect. The prior credit-bureau voluntary changes (paid medical debt removed; unpaid debt under $500 not reported) remain in place.
Cited in: Hospital Institutional Architecture.

Pennsylvania Constitution

Article I § 1. "All men are born equally free and independent..." Foundation for Pennsylvania liberty-and-due-process protections.
Cited in: applicable across D21.

Federal statutory layer

Medicare framework

Social Security Act Title XVIII (Medicare). 42 U.S.C. § 1395 et seq. The foundational statutory architecture; § 1395 establishes program framework; § 1395cc establishes provider agreements (Conditions of Participation basis); § 1395w-21 et seq. establishes Part C Medicare Advantage (Balanced Budget Act of 1997; amended by MMA 2003); § 1395w-101 et seq. establishes Part D (MMA 2003); § 1395i et seq. establishes Part A Trust Fund. § 1834(m) establishes Medicare telehealth payment architecture. Statutory stability: HIGH; administrative vulnerability: MODERATE.
Cited in: Medicare Delivery · Specialty.

Medicare Modernization Act of 2003 (P.L. 108-173). Restructured Part C as Medicare Advantage; created Part D; established Medicare Savings Account framework; established competitive bidding for durable medical equipment.

Inflation Reduction Act of 2022 (P.L. 117-169) — Medicare Drug Price Negotiation Program. Adds Medicare Part E (Drug Price Negotiation) at § 1191 of the Social Security Act; authorizes the Secretary of HHS to negotiate prices for certain high-cost single-source drugs covered under Medicare Part D (and beginning 2028, Part B). Establishes annual Part D out-of-pocket cap — $2,100 in 2026, up from $2,000 in 2025; eliminates prior catastrophic coverage cost-sharing; restructures Part D benefit phases; establishes inflation rebates. § 1192 drug selection criteria; § 1194 negotiation process; § 1193 coverage requirement. Round 1 effective January 1, 2026 (10 Part D drugs); Round 2 effective January 1, 2027 (15 drugs). Trump EO 14273 (April 15, 2025) directs program modifications without dismantling. CY 2026 Part D Redesign Program Instructions issued by CMS April 7, 2025.
Cited in: Medicare Delivery · Specialty.

Medicare Part B ESRD coverage. 42 U.S.C. § 1395rr. 100% coverage for ESRD beneficiaries regardless of age after qualifying period. CMS ESRD Conditions for Coverage at 42 C.F.R. Part 494.
Cited in: Specialty.

Medicare telehealth statutory architecture. § 1834(m); CARES Act (P.L. 116-136) plus CAA 2021 plus CAA 2023 plus CAA 2024 plus continuing resolutions plus Consolidated Appropriations Act 2026 (signed February 3, 2026) extending Medicare telehealth flexibilities through December 31, 2027. CY 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F, October 31, 2025) finalized permanent provisions including direct supervision via real-time audio-visual telecommunications and behavioral / mental health audio-only telehealth.
Cited in: Specialty.

Medicaid framework

Social Security Act Title XIX (Medicaid). 42 U.S.C. § 1396 et seq. Federal-state grant-in-aid framework. Sets mandatory eligibility categories, mandatory benefits, FMAP architecture, and provider-tax framework.
Cited in: every D21 sub-domain.

Children's Health Insurance Program — Title XXI. 42 U.S.C. § 1397aa et seq.
Cited in: Medicaid Delivery.

42 C.F.R. Part 438 — Medicaid Managed Care. CMS-administered federal regulatory framework governing all Medicaid managed-care contracts; network adequacy; actuarial soundness; enrollee protections; appeals; MLR requirements.
Cited in: every D21 sub-domain.

Section 1115 demonstration waivers and Section 1915(b) / (c) waivers. Pennsylvania operates Community HealthChoices under concurrent 1915(b) (mandatory managed care) and 1915(c) (home and community-based services) waivers.
Cited in: Medicaid Delivery.

CMS Medicaid FQHC PPS architecture. 42 C.F.R. Part 405 Subpart X.
Cited in: FQHC & Safety-Net.

One Big Beautiful Bill Act of 2025 (P.L. 119-21). Signed July 4, 2025. CMS administratively names "Working Families Tax Cut" (WFTC). Section 71107 establishes 6-month eligibility redeterminations effective December 2026; Section 71109 noncitizen Medicaid restrictions effective October 1, 2026; Section 71115 provider-tax safe-harbor stepdown from 6.0% to 5.5% beginning FY 2028 and to 3.5% by FY 2032; Section 71117 MCO-tax tightening (effective July 4, 2025 with three-year CMS transition); Section 71119 community-engagement work requirements (80 hours/month) effective January 1, 2027; Section 71401 Rural Health Transformation Fund ($10 billion annually FY 2026-2030; $5B equal-state allocation plus $5B rurality-and-application-based). CCBHCs / FQHCs / RHCs exempted from new cost-sharing. IMD exclusion unchanged. CMS Interim Final Rule due June 1, 2026; beneficiary outreach must begin no later than December 31, 2026.
Cited in: every D21 sub-domain.

ACA and commercial-insurance framework

Patient Protection and Affordable Care Act. 42 U.S.C. § 18001 et seq. Establishes ACA marketplace; APTC architecture (26 U.S.C. § 36B); CSR architecture (42 U.S.C. § 18071); essential health benefits; pre-existing-condition exclusion prohibition; medical loss ratio requirements; rate review.
Cited in: ACA & Commercial.

ACA § 1302 — Essential Health Benefits. 42 U.S.C. § 18022. Requires non-grandfathered individual and small-group plans to cover ten essential health-benefit categories including mental-health and substance-use-disorder services.

ACA § 2713 — Preventive Services. 42 U.S.C. § 300gg-13. USPSTF Grade A/B preventive services at no cost-sharing. Upheld by Kennedy v. Braidwood Management.

American Rescue Plan Act 2021 / Inflation Reduction Act 2022 — Enhanced PTC architecture. Removed 400% FPL eligibility cliff; capped premium at 8.5% of household income. Expired December 31, 2025 per Congress's non-extension. H.R. 1834 "Health Subsidies Extension Measure" House-passed January 8, 2026 (230-196; 17 Republicans crossing including PA-1 Fitzpatrick, PA-7 Mackenzie, PA-8 Bresnahan); Senate CARE Act 2-year alternative draft circulating but not advanced; December 2025 Senate proposals S. 3385 and S. 3386 failed cloture.
Cited in: ACA & Commercial · Hospital · FQHC & Safety-Net.

No Surprises Act. P.L. 116-260 Div. BB. Effective January 1, 2022. Protects consumers from surprise medical bills for emergency services and out-of-network services at in-network facilities; establishes Independent Dispute Resolution (IDR) architecture.
Cited in: Hospital · ACA & Commercial.

ERISA. 29 U.S.C. § 1001 et seq. Governs employer-sponsored health insurance plans; preempts state regulation of self-funded employer plans (federal regulatory floor only). Self-funded employer plans cover approximately 60% of employer-sponsored coverage nationally.
Cited in: ACA & Commercial · BH & SUD Delivery.

Hospital institutional framework

EMTALA. 42 U.S.C. § 1395dd. Conditions Medicare provider agreement on emergency medical screening and stabilization for any individual presenting at a Medicare-participating hospital ED, regardless of payer status.
Cited in: Hospital · Specialty.

IRC § 501(r) (added by ACA § 9007). 26 U.S.C. § 501(r). Tax-exempt status conditions for nonprofit hospitals: community health needs assessment every three years with implementation strategy; financial assistance policy; billing and collection requirements; emergency medical care policy. Treasury Regulation 1.501(r) implements. Form 990 Schedule H reporting.
Cited in: Hospital.

HIPAA. 45 C.F.R. Parts 160, 164. Privacy Rule, Security Rule, Breach Notification Rule.
Cited in: Hospital.

Hospital Price Transparency Rule. 45 C.F.R. § 180.40 et seq. Requires hospitals to publish payer-specific negotiated rates, gross charges, and cash-discount prices. Only 30% of PA hospitals compliant per independent audit.
Cited in: Hospital.

CMS Conditions of Participation. 42 C.F.R. Parts 482-485.
Cited in: Hospital.

FQHC and safety-net framework

Section 330 of the Public Health Service Act. 42 U.S.C. § 254b. Authorizes HRSA Health Center Program; sets community-board governance (51% patient board members); sliding-fee scale for income-qualifying patients; required MUA / MUP designation; FTCA medical malpractice coverage for HRSA-deemed entities.
Cited in: FQHC & Safety-Net.

Community Health Center Fund (CHCF). Authorized through annual Consolidated Appropriations Acts. FY 2026 at $4.6 billion (largest annual increase in a decade per NACHC) via 2026 CAA; authorization expires December 31, 2026. NACHC has requested multi-year reauthorization at $5.8 billion per year for at least 3 years; not multi-year reauthorized since 2019.
Cited in: FQHC & Safety-Net.

340B Drug Pricing Program. 42 U.S.C. § 256b. Authorizes HRSA to administer 340B providing discounted prescription drug pricing to covered entities including FQHCs, disproportionate-share hospitals, and certain other safety-net entities. The 340B Rebate Model Pilot Program was vacated and remanded in AHA v. Kennedy (D. Me., February 10, 2026); HRSA RFI 91 Fed. Reg. 7,287 (February 17, 2026) closed April 20, 2026 with 5,576 comments.
Cited in: FQHC & Safety-Net · Specialty.

H.R. 7391 — Community Health Center Drug Pricing Protection Act. Introduced February 5, 2026 by Reps. Jack Bergman (R-MI) and Jake Auchincloss (D-MA). PA cosponsors include Rep. Rob Bresnahan (PA-8), Rep. Madeline Dean (PA-4), and Rep. Lloyd Smucker (PA-11) per PACHC.
Cited in: FQHC & Safety-Net.

Federal Tort Claims Act. 28 U.S.C. § 2671 et seq. Provides medical malpractice coverage for HRSA-deemed FQHCs and their providers.
Cited in: FQHC & Safety-Net.

Ryan White HIV/AIDS Treatment Extension Act. 42 U.S.C. § 300ff et seq.
Cited in: FQHC & Safety-Net · Specialty.

Title X family planning. 42 U.S.C. §§ 300 to 300a-6. Authorized 1970; HHS Office of Population Affairs (OPA) administration; 42 C.F.R. Part 59 regulations. FY 2025 $286.5M; FY 2026 $286M enacted. April 1, 2025 administration withholding of 16 grantees / 22 grants / $65.8M; NFPRHA lawsuit; December 2025 restoration; March 13, 2026 HHS one-week guidance window; April 1, 2026 OPA $261M continuation grants to 86 organizations; April 3, 2026 new guidelines.
Cited in: Specialty.

Behavioral health and parity framework

MHPAEA. 29 U.S.C. § 1185a; 42 U.S.C. § 300gg-26; 26 U.S.C. § 9812 (added by P.L. 110-343 Title V Subtitle B). Requires group health plans and individual market plans to apply financial requirements and treatment limitations to MH/SUD benefits no more restrictively than the predominant requirements applied to medical/surgical benefits.

Consolidated Appropriations Act of 2021 — § 203 MHPAEA Amendment. 29 U.S.C. § 1185a(a)(8); 42 U.S.C. § 300gg-26(a)(8). Requires comparative analyses of NQTLs.

September 2024 MHPAEA Final Rule. 89 Fed. Reg. 77586 (September 23, 2024); effective November 22, 2024 with staggered applicability for plan years on/after January 1, 2025 and January 1, 2026. Trump administration partial non-enforcement policy May 9-15, 2025 covering portions "new in relation to 2013 Final Rule" until ERIC litigation resolves plus 18 months. EO 14219 cited as policy basis. 2013 Final Rule plus CAA 2021 obligations remain operative.
Cited in: BH & SUD Delivery.

SAMHSA 42 C.F.R. Part 8 OTP Final Rule. 89 Fed. Reg. 7528 (February 2, 2024); effective April 2, 2024; compliance October 2, 2024. Correction effective February 23, 2026 (91 Fed. Reg. 7456). Codifies COVID-era OTP flexibilities permanently.
Cited in: BH & SUD Delivery.

MAT Act / § 1262 of Consolidated Appropriations Act 2023 (P.L. 117-328). Removed DATA Waiver requirement for buprenorphine OUD prescribing.
Cited in: BH & SUD Delivery.

DEA-HHS Telemedicine Flexibility Final Rule (2025). Finalized telemedicine flexibility regulations making buprenorphine-related telemedicine prescribing permanent.
Cited in: BH & SUD Delivery.

National Suicide Hotline Designation Act of 2020. P.L. 116-172. Authorized 988 Suicide and Crisis Lifeline as nationwide 3-digit dialing code. SAMHSA administers through Vibrant Emotional Health contractor.
Cited in: BH & SUD Delivery.

42 C.F.R. Part 2 — Confidentiality of Substance Use Disorder Patient Records. Aligned with HIPAA per CAA 2021 modifications; 42 C.F.R. Part 2 Final Rule (February 2024).
Cited in: BH & SUD Delivery.

CCBHC Medicaid Demonstration. § 223 of Protecting Access to Medicare Act of 2014; expanded by CCBHC Expansion Act. SAMHSA administers CCBHC expansion grants.
Cited in: BH & SUD Delivery.

Infrastructure and cross-cutting framework

IIJA — Infrastructure Investment and Jobs Act ("Bipartisan Infrastructure Law"). P.L. 117-58. Signed November 15, 2021; authorized $1.2 trillion total / $550 billion new investment FY 2022-FY 2026. Expires September 30, 2026. No reauthorization bill introduced as of May 2026. BASICS Act H.R. 7437 introduced February 9, 2026 by Reps. Bresnahan (R-PA) and McDonald Rivet (D-MI) is bipartisan legislative activity. Cross-reference D13 SD7 G13-SD7-01 PRINCIPAL ANCHOR.
Cited in: Specialty.

Veterans Choice / Community Care Network (CCN). 38 U.S.C. § 1703 (MISSION Act of 2018; CCN 2.0). Cross-reference D24 SD1 plus SD4.

OSHA Bloodborne Pathogens Standard. 29 C.F.R. § 1910.1030.

Hazard Communication Standard. 29 C.F.R. § 1910.1200.

ACGME. Private accreditation body; accredits residency and fellowship training programs at PA-3 anchor systems; ACGME accreditation conditions Medicare GME funding via hospital cost reports.
Cited in: Hospital · Specialty.

The Joint Commission. Private accreditation body; deemed status for Medicare CoP compliance.

Civil rights and advocacy. Title VI of the Civil Rights Act (42 U.S.C. § 2000d); Section 504 of the Rehabilitation Act (29 U.S.C. § 794); Section 1557 of the ACA (42 U.S.C. § 18116); Americans with Disabilities Act Title II (42 U.S.C. § 12131 et seq.); PAIMI Act of 1986 (42 U.S.C. § 10801 et seq.).

State statutory layer

Pennsylvania general framework

Pennsylvania Public Welfare Code. 62 P.S. § 101 et seq. Establishes PA Medical Assistance; authorizes PA DHS to operate the Medicaid program; authorizes provider-tax architecture (currently 6% on hospital net inpatient revenue; subject to OBBBA stepdown).
Cited in: Medicaid · FQHC & Safety-Net.

55 Pa. Code Ch. 1101 et seq. PA Medical Assistance regulations; implements 62 P.S. through PA DHS regulations.

PA Act 22 of 2011. Codified PA HealthChoices managed-care mandatory enrollment framework.

PA Health Care Facilities Act. 35 P.S. § 448.101 et seq. Authorizes PA Department of Health to license hospitals.
Cited in: Hospital.

28 Pa. Code Ch. 101 et seq. PA hospital licensing regulations.

PA MCARE Act. 40 P.S. § 1303.101 et seq. Medical Care Availability and Reduction of Error Act; establishes PA Patient Safety Authority; MCARE Fund. 2024 tort reform shortened certain claim windows to 18 months.
Cited in: Hospital.

PA Act 77 of 1968 (Hospital Charity Care). Mandates PA hospitals to offer financial assistance / charity care programs.
Cited in: Hospital.

PA Fair Credit Extension Uniformity Act. 73 P.S. § 2270.4. Prohibits unfair and deceptive practices in debt collection including medical debt collection.
Cited in: Hospital.

PA wage garnishment prohibition for medical debt. 42 Pa. C.S. § 8127.
Cited in: Hospital.

PA medical debt credit-reporting prohibition. Pennsylvania prohibits reporting patient medical debt to credit agencies; debt is voided if reported in violation.
Cited in: Hospital.

PA medical debt statute of limitations. 42 Pa. Consol. Stat. § 5525(7). Four years from last payment activity.
Cited in: Hospital.

HUP v. Commonwealth (charitable-exemption standard; PA Act 55 of 1997 five-part test). Cross-reference D9 SD4 PILOET PRINCIPAL ANCHOR.

Pennsylvania insurance and exchange framework

Pennsylvania Insurance Department Act. 40 P.S. § 1 et seq. Authorizes PA Insurance Department to regulate Pennsylvania commercial insurance market.

Pennsylvania Health Insurance Exchange Authority Act (PA Act 42 of 2019). 35 P.S. § 449.6101 et seq. Establishes PHIEA as a public agency to operate Pennie.
Cited in: ACA & Commercial.

PA Mental Health Parity Act (PA Act 50 of 2004). 40 P.S. § 908-1 et seq. PA state MHPAEA implementation for commercial plans regulated under PA insurance code.
Cited in: BH & SUD Delivery · ACA & Commercial.

PA Act 54 of 2024 — State Health Insurance Exchange Affordability Program. Pennsylvania's pending state-level affordability program; established but unfunded as of May 2026.
Cited in: ACA & Commercial.

Pennsylvania Medicare Supplement Insurance Act (40 Pa. Code Ch. 89). Pennsylvania Medigap consumer-protection framework. Pennsylvania does not have a state-level Medigap birthday rule. Proposed legislation (Co-Sponsorship Memo 47375, 2025-2026 Regular Session) would create a 60-day annual birthday-rule switching window; not enacted as of May 2026. Pennsylvania prohibits Medicare excess charges.
Cited in: Medicare Delivery.

Pennsylvania mental-health and SUD framework

Pennsylvania Mental Health Procedures Act. 50 P.S. § 7101 et seq. Cross-reference D3 verified file for substantive analysis.

PA Act 98 of 2022 (Telehealth permanence). Permanently removed PA DHS regulations prohibiting payment for audio-only telehealth in outpatient psychiatric and drug-and-alcohol clinic services.
Cited in: BH & SUD Delivery · Specialty.

Pennsylvania Behavioral HealthChoices program. PA Medicaid behavioral-health carve-out architecture; each county assigned to a single designated BH-MCO based on county of residence. 5 BH-MCOs across 67 counties.
Cited in: BH & SUD Delivery.

PA DDAP authorizing statutes. Authorize SUD treatment facility licensing in Pennsylvania.

Pennsylvania state agencies

Pennsylvania Department of Human Services (DHS). Office of Medical Assistance Programs (OMAP); Office of Long-Term Living (OLTL); Office of Mental Health and Substance Abuse Services (OMHSAS).

Pennsylvania Department of Health (PA DOH). Licenses hospitals under PA Health Care Facilities Act; conducts surveys under federal Medicare CoP delegation.

Pennsylvania Insurance Department. Commissioner: Michael Humphreys. Regulates commercial insurance market; enforces PA Mental Health Parity Act on PA-regulated commercial plans.

Pennsylvania Department of Drug and Alcohol Programs (DDAP). Licenses SUD treatment facilities; coordinates with federal SAMHSA.

Pennsylvania Health Insurance Exchange Authority (PHIEA, dba Pennie). Pennie Director: Devon Trolley. Operates Pennsylvania's state-based ACA exchange; customer service 1-844-844-8040.

Pennsylvania Department of Aging — PA MEDI Medicare Counseling Program (statewide SHIP). Central counseling line 1-800-783-7067.

PA Independent Enrollment Broker (IEB). Contracted with PA DHS to provide LTSS choice counseling; 1-844-824-3655 plus 1-877-550-4227 for Functional Eligibility Determination; operates enrollchc.com.

PA Hospital and Healthsystem Association (HAP). Industry association representing PA hospitals.

Pennsylvania Patient Safety Authority. Receives patient safety event reports.

Livanta — Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Pennsylvania. CMS-contracted independent organization handling first-level Medicare appeals.

Local layer

Philadelphia Home Rule Charter (1951)

Provides the structural authority for Philadelphia's consolidated city-county government. Constitutional foundation for DBHIDS dual city/county authority and the CBH single-MCO HealthChoices BH Home Rule innovation.

Philadelphia Code

Title 6 — Health. Authorizes the Philadelphia Department of Public Health (PDPH) and DBHIDS operational architecture; the Philadelphia behavioral-health-Medicaid carve-out is administered through CBH per Philadelphia Code architecture.

Title 9 § 9-1100 et seq. Philadelphia anti-discrimination protections applicable to health-insurance and healthcare contexts.

Title 17 — Real Estate. Local real-estate-tax architecture (cross-reference D9 SD4 PILOET PRINCIPAL ANCHOR).

Philadelphia agencies and institutions

Philadelphia Department of Public Health (PDPH). 1101 Market Street, Philadelphia, PA 19107. Operates Philadelphia health center system including Health Centers 4, 5, 6, 9, Strawberry Mansion. Spearheads the 2025 SEPA Regional CHNA with Health Care Improvement Foundation.

Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Contracts CBH as Philadelphia's single BH-MCO. Interim Commissioner since April 16, 2024: Marquita C. Williams.

Community Behavioral Health (CBH). 801 Market Street, 7th Floor, Philadelphia, PA 19107. 501(c)(3) nonprofit single BH-MCO since February 1997. CEO: Donna E.M. Bailey, MSEd, MBA. Approximately 420,000 Philadelphia Medicaid recipients; 100,700+ active service users in 2023; $860M+ expenditures. School-based BH program since 2003; Evidence-based Practice and Innovation Center since 2013.

Philadelphia Corporation for Aging (PCA). 642 N. Broad Street, Philadelphia, PA 19130. Philadelphia Area Agency on Aging; operates local network of PA MEDI Medicare counselors.

Philadelphia County Assistance Office (CAO). Multiple locations (1410 W. Erie Avenue, Philadelphia, PA 19140; 1701 S. Broad Street, Philadelphia, PA 19148). Implements PA DHS-administered Medicaid eligibility determinations at the county level.

Philadelphia Commission on Human Relations (PCHR). Enforces Philadelphia anti-discrimination ordinances.

PA-3 anchor hospital institutional infrastructure

Penn Medicine. Hospital of the University of Pennsylvania (3400 Spruce Street); Penn Presbyterian Medical Center (51 N. 39th Street); Pennsylvania Hospital (800 Spruce Street); Abramson Cancer Center; Penn Heart and Vascular Center.

Temple Health. Temple University Hospital (3401 N. Broad Street); Episcopal Campus (100 E. Lehigh Avenue); Temple Lung Center.

Jefferson Health. Thomas Jefferson University Hospitals (111 S. 11th Street); Einstein Medical Center (5501 Old York Road); Jefferson Methodist (2301 S. Broad Street); Sidney Kimmel Cancer Center; Vickie and Jack Farber Institute for Neuroscience. Post-2021 Einstein merger consolidated under Jefferson Health.

Children's Hospital of Philadelphia (CHOP). 3401 Civic Center Boulevard plus 50+ Care Network locations across PA and NJ.

Specialty hospitals. Wills Eye Hospital (840 Walnut Street) ophthalmology; St. Christopher's Hospital for Children (1601 W. Allegheny Avenue) pediatric (Tower Health-owned). Hahnemann University Hospital closed 2019 — structural-precedent for safety-net institutional fragility.

PA-3 FQHC and safety-net infrastructure

Philadelphia FIGHT. 1233 Locust Street. Ryan White principal provider in PA-3; HIV/AIDS specialty.

Puentes de Salud. 1700 South Street. Latino community health; FQHC look-alike.

MANNA. 420 N. 20th Street. Medically tailored meals plus clinical services.

Resources for Human Development (RHD). 4700 Wissahickon Avenue.

Family Practice & Counseling Network (FPCN). 1900 N. 9th Street. FQHC look-alike.

PA-3 psychiatric inpatient infrastructure

Friends Hospital. 4641 Roosevelt Boulevard.

Belmont Behavioral Health. 4200 Monument Road.

Inpatient psychiatric departments at Penn (HUP; Penn Presbyterian; Pennsylvania Hospital), Temple, Jefferson, and CHOP (pediatric). Horsham Clinic (suburban; cross-county boundary).