As of this writing, Pennsylvania’s state government is operating in its sixth month without a state budget for the 2015-2016 fiscal year which began July 1. Keeping up-to-date with even the status of budget negotiations is no easy task, as things continue to be in a state of flux, even at this late date. However, there does appear to be light at the end of the tunnel and hope that the stalemate could end soon.
After passing opposing spending plans earlier this week, House and Senate leaders are back to the table with Gov. Wolf trying to resolve differences and negotiate an end to the gridlock. The budget framework that is currently under discussion would include somewhere between $30.3 and $30.8 billion in state spending and rely on up to $2 billion in new tax revenues. The framework also includes a significant increase in funding for public schools –a key element for Gov. Wolf – and separate reforms to the state’s public pension systems and liquor system – both priorities of the GOP-controlled legislature.
In the midst of the ongoing budget stalemate, there have been developments on a few measures of importance to physicians and patients this fall. Below are a few highlights on legislative activity.
Public Hearing Held on CRNP Independent Licensure
On October 22, the House Professional Licensure Committee held a public hearing on House Bill 765, sponsored by Rep. Jesse Topper (R-Bedford County). HB 765 would allow Certified Registered Nurse Practitioners (CRNPs) to practice independently and eliminate the current requirement that CRNPs have a collaborative agreement with a physician in order to diagnose, treat and prescribe to patients in Pennsylvania. PAMED is strongly opposed to the legislation.
Former PAMED President Karen Rizzo, MD, testified at the public hearing on behalf of PAMED. Also testifying in opposition to HB 765 were physician leaders representing the Pennsylvania Academy of Family Physicians, the Pennsylvania Chapter of the American Academy of Pediatrics, and the Pennsylvania Osteopathic Medical Association, and a PAMED member who had been a licensed CRNP before attending medical school and becoming a family physician. Additional testimony opposing HB 765 was provided by Ann Peton, MPH, Director of the National Center for the Analysis of Healthcare Data, who spoke about workforce migration trends nationwide and countered claims that nurse practitioners are more likely to practice in rural areas after gaining independent practice authority.
Nearly two-dozen PAMED members attended the public hearing on HB 765, which was held at the State Capitol in Harrisburg. The House Professional Licensure Committee also heard testimony from a panel of individuals in support of HB 765 and the independent practice of nurse practitioners. Committee members then had an opportunity to ask questions of those who testified.
At this time, we are confident that we have a great deal of support in the House on this issue. We do not expect HB 765 to be scheduled for a vote in the near future. We are also closely monitoring the Senate version of the bill – SB 717, sponsored by Sen. Pat Vance (R-Cumberland County) – which is perhaps more likely to move. Sen. Vance recently announced her intention to retire at the end of her current term.
Legislation to legalize marijuana for medicinal use is awaiting consideration by the House of Representatives. SB 3, which passed the Senate overwhelmingly in May, is largely expected to be the measure ultimately voted on. At this time, over 200 amendments to SB 3 have been filed, both by House members who support medical marijuana and have specific views on what should be included in the legislation, and by members who remain staunchly opposed to the measure and are seeking to block its passage. Legalization of marijuana remains a contentious subject among House leadership. Given the fragile state of budget negotiations, it is expected that consideration of a bill will be delayed until the new year.
Of the 200-plus amendments filed to SB 3, one particular amendment reflects recommendations issued by a House workgroup this past summer. The workgroup, which was comprised of legislators with varying opinions on medical marijuana legalization, was charged by House Republican leadership to come up with a compromise proposal that would garner enough support to pass the lower chamber. However, as evidenced by the number of amendments offered to SB 3, not everyone is on board with the workgroup’s product.
PAMED remains opposed to broad-based legalization of marijuana for medical use. PAMED’s 2015 House of Delegates reaffirmed this policy, noting marijuana’s ongoing status as a federal Schedule I controlled substance and the need for adequate and well-controlled studies of marijuana’s effects. Given that public opinion is overwhelmingly supportive of marijuana legalization, however, we expect the legislature to vote on the measure sometime in 2016.
Streamlining the Physician Credentialing Process
Rep. Matt Baker (R-Tioga) introduced legislation in November that would improve the physician credentialing process in Pennsylvania, making it timelier and more uniform across insurers. The legislation is strongly supported by PAMED.
HB 1663 specifically addresses the problem of unwarranted delays by health insurers in credentialing applicants for inclusion in their networks. Hospitals and physician practices routinely face the situation where a newly hired health care professional who is fully licensed and qualified to provide care is not reimbursed by insurers for months while the insurers work their way through an unnecessarily and cumbersome credentialing process. This costs hospitals and physicians money, drives up the cost of health care, and limits access to care by keeping fully licensed and qualified providers on the sidelines until they are credentialed by insurers.
HB 1663 will establish a standardized process and timeline for insurer action on credentialing applications. The legislation introduced would require all insurers in Pennsylvania to accept the Council for Affordable Quality Healthcare (CAQH) credentialing application and provide for provisional credentialing of a provider when a determination is not made within 30 days of a submitted application. HB 1663 is currently awaiting consideration by the House Health Committee.
PAMED is also working closely with the Department of Human Services (DHS) to ensure more timely credentialing of physicians within the state’s Medicaid program. After discussions led by PAMED, DHS announced that beginning in 2016, Physical Health Managed Care Organizations (PH-MCOs) will be required to begin the credentialing process upon receipt of a provider’s application and must complete the credentialing process within 60 days.
Improving Prior Authorization Processes
Rep. Marguerite Quinn (R-Bucks County) will soon be introducing legislation to streamline and standardize the prior authorization process in Pennsylvania. The legislation is strongly supported by PAMED.
Many health plans require physicians to obtain prior authorization for certain procedures or treatments before they can be administered. While the process is intended to minimize overuse of health care services, it often becomes an extremely burdensome process for physicians and their patients. Lack of transparency and standardization in prior authorization requirements not only makes the process difficult and time consuming, but can also result in delays in needed care for Pennsylvania residents.
Rep. Quinn’s legislation would increase transparency and consistency in prior authorization criteria; establish standards and reduce the overuse of prior authorization; lessen manual processes and enhance the electronic exchange of information; develop a standard prior authorization form; and improve response times for prior authorization determinations. These steps will go a long way toward addressing administrative waste in our health care delivery system, resulting in both cost savings and improved access to care.
PAMED sent a letter supporting Rep. Quinn’s legislation to all House members in early December, urging them to co-sponsor the bill.
Reauthorization of CHIP
The state House and Senate gave final approval this week to a bill that reauthorizes Pennsylvania’s Children’s Health Insurance Program (CHIP), which was set to expire at the end of 2015. HB 857, sponsored by Rep. Tina Pickett (R-Bradford County), extends the life of CHIP until the end of 2017 and also moves the program from the Pennsylvania Insurance Department to the Department of Human Services. The bill is currently awaiting the Governor’s signature to become law, which will likely happen in the coming days.
CHIP provides health insurance to children in Pennsylvania under age 19 who don’t qualify for Medical Assistance. In August, Gov. Wolf announced a number of changes to CHIP would take effect on Dec. 1, 2015, to ensure that the program meets minimum essential coverage requirements of the Affordable Care Act. The changes included the following:
- All CHIP plans will cover certain preventive care services—such as oral hygiene education and dietary instruction—without cost sharing in the form of copayments, coinsurance, or deductibles.
- Annual and lifetime limits will be eliminated on the cost of some specific services and equipment like durable medical equipment, hearing aids, pediatric vision and dental service, including orthodontic services.
- Health plans must provide parity between mental health/substance abuse benefits and medical/surgical benefits.
In April 2015, federal funding of CHIP was extended for two years under H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015.