Pennsylvania Medical Society Quarterly Legislative Update
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As June arrives in Harrisburg, conversations over the 2017-2018 state budget are well underway. Governor Tom Wolf kicked off the process with his budget address in February that outlined $32.2 billion in spending, including pledges for increased investments in education, seniors, and substance abuse services, while avoiding new broad-based tax increases. The Governor’s budget offsets these increased investments by proposing a savings of $2 billion through waste cutting and government efficiency measures.
In response, in April, the Republican-majority House passed its budget bill by a strong party line vote (114-84) that proposes $31.5 billion in spending. The $815 million gap between the two plans is the closest Governor Wolf and the GOP legislature have had at this point in the process. More work still needs to be done, but for now, it seems realistic that the Governor and the General Assembly could agree to a finalized budget by the June 30, 2017 constitutional deadline.
Beyond the budget, the General Assembly has taken action on several bills of interest to PAMED already this year. Below is an update on that activity.
SB 25 – CRNP Independent Practice (Introduced by Senator Bartolotta)
This legislation would, among other things, eliminate the requirement that the State Board of Medicine or Osteopathic Medicine approve the combined practice of CNPs with physicians. It would also allow CNPs to be eligible to practice without a collaborative or written agreement, including being able to prescribe medications under their scope of practice. SB 25 was voted out of the Senate Consumer Protection and Professional Licensure Committee on April 18, 2017. It was subsequently passed in the Senate on April 26, 2017 (39-10).
In addition to government relations staff working with legislators from both the House and Senate to impress upon them the importance of physician-led teams working with patients, PAMED also generated a call-to-action targeted to physicians from the Senate committee members’ districts in the days leading up to the vote.
Despite the final vote count, consideration of the bill, and more specifically, internal caucus discussions, generated a robust exchange between senators who vehemently oppose the measure and those who favor its passage. While a number of senators voiced serious concern about scheduling the bill for consideration, Senator Kim Ward’s was the loudest as she made a significant attempt to amend the legislation to more narrowly define those specialty areas in which CNPs could practice. Ultimately, her amendment was not offered but her efforts generated productive conversations. Unfortunately, those discussions did not significantly move the needle but did positively affect some votes.
The legislation will now move to the House Professional Licensure Committee chaired by Rep. Mark Mustio (R-Allegheny). Although the measure was moved swiftly through the senate, we anticipate its progress will slow considerably in the House of Representatives.
Prior Authorization Legislation –Introduced by Rep. Marguerite Quinn (R-Bucks)
Representative Marguerite Quinn, along with 38 bi-partisan co-sponsors introduced HB 1293. This legislation will improve transparency, accessibility and consistent application of prior authorization by including a standard definition. It will also significantly streamline the process by requiring insurers to make available an electronic communications network that permits prior authorization requests to be submitted electronically, and authorizations and adverse determinations to likewise be returned electronically.
Over the past several months, government relations staff has been working closely with Rep. Quinn in developing this legislation and making improvements over last session’s version. Prior to its introduction, staff met with house members to explain the need for the legislation and to secure an adequate number of legislative sponsors.
As a PAMED priority, staff is in the process of finalizing the physician and patient grassroots initiative in an effort to generate a considerable volume of constituent/patient contacts with legislators. In addition, PAMED staff has reached out to our network of practice administrators to learn more about the need for prior authorization reform and to collect examples of patients whose care has either been delayed by this process or potentially put at risk. Staff’s intention is to share these patient vignettes with the legislature. Other grassroots activities focused on key legislators is also underway.
At this juncture, the House Bill 1293 has not been referred to committee. Once that process has taken place, PAMED will engage in direct physician contacts with committee members and begin the process of educating legislators as to how this process negatively impacts patient care.
Pennsylvania Orders for Life-Sustaining Treatment (POLST)
PAMED embarked on the POLST initiative several years ago in cooperation with a broad coalition of 27 different organizations. While legislative language was finalized in the summer of 2016, the decision was made to wait until 2017 to seek legislative sponsors. As planned, earlier this year PAMED was successful in securing Sen. Gene Yaw and Rep. Bryan Cutler to be our lead sponsors of our POLST initiative. Rep. Hickernell, an early advocate of this initiative, joined Rep. Cutler as a “joint sponsor” in the house. All three legislators, specifically our lead sponsors, are well regarded in their respective caucuses. Senator Yaw, well known as a “thought leader” within the Senate republican caucus, was very sensitive to the need to shed light on the importance of POLST. Rep. Cutler, also highly regarded, is universally recognized for his expertise on healthcare related issues and is a member of the House republican leadership team as its Majority Whip. Rep. Cutler’s interest in POLST largely stems from personal experience surrounding the death of his parents.
Prior to the formal introduction of POLST legislation, PAMED organized a “key legislative staff” briefing that served as a primer to an issue that was largely unknown in the General Assembly. Presenting at the briefing were Drs. Judy Black (Pennsylvania National POLST Paradigm Program), Alex Nesbitt (Susquehanna Hospice and Palliative Care) and Daniel Kimball who represented PAMED (All three PAMED members). Seventeen senior level legislative staffers attended the event.
On April 18, Sen. Yaw and Rep. Cutler held a joint press event to publicly announce the introduction of their respective pieces of legislation (Senate Bill 623 and House Bill 1193). The press event drew a number of legislative co-sponsors and members of our coalition to stand behind our sponsors during the event. Having two strong legislative sponsors clearly demonstrated unity between the two legislative bodies.
In an effort to keep all 27 coalition members up-to-date on the most recent legislative developments and to provide a means of verbally exchanging information, PAMED has been hosting a monthly telephone conference.
To date, neither bill has been formally introduced as PAMED and the bill sponsors continue to tweak legislative language. Formal introduction is expected in the coming weeks.
Working in cooperation with the Hospital and Health Systems Association (HAP), PAMED was successful in securing the passage of House Bill 125 from the House Health Committee. The legislation was subsequently passed by the full House on May 24, 2017 (190-0). HB 125 will now be considered by the Senate, where it will continue to face strong opposition from the entire insurance industry.
Last session, legislation was introduced in both the Senate and House of Representatives to provide statutory guidelines related to the practice of telemedicine. As expected, the bills did not move but succeeded in generating discussion among key stakeholders. This session, ongoing efforts, largely taking place in the Senate, to address concerns from all stakeholders has delayed formal introduction of legislation. Two primary issues, guaranteed reimbursement for telemedicine services and a question of mandating the availability of video (PAMED and HAP are opposed to audio only) have thus far slowed down the advancement of this issue. PAMED is hopeful that these issues will be resolved in the near term and that legislation will be introduced shortly thereafter.
Our legislative sponsors remain the same from last session — Sen. Elder Vogel and Rep. Marguerite Quinn.
Federal Medical Liability Legislation
HR 1215 has cleared both the House Judiciary and the House Energy and Commerce committees. PAMED had previously sent a letter to the House delegation from PA as well as key
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