Pennsylvania Medical Society Quarterly Legislative Update
With the end of June rapidly approaching, there appears to be some optimism within the state legislature that a budget for the 2016-2017 fiscal year could be enacted by the constitutional deadline of June 30. Such an accomplishment would be in stark contrast to the previous year’s budget impasse, which didn’t conclude until Gov. Tom Wolf let the budget legislation become law without his signature in March, nine months past its due date.
The state is currently facing a budget deficit estimated to be approximately $1.8 billion. Earlier this year, Governor Wolf proposed a $33.3 billion spending plan for 2016-2017 that would increase funding for schools, public pensions, human services and prisons, and rely on $2.7 billion in new or increased taxes. Republicans, who hold a large majority in both the state Senate and the House of Representatives, have consistently balked at broad based tax increases.
Nonetheless, everyone seems to be eager to avoid a protracted budget impasse like last year’s – perhaps in part because it’s an election year for all 203 House seats and half of the 50 Senate seats, and legislators are eager to get back to their districts to campaign. The latest news at the time of this writing is that Gov. Wolf has backed off of the idea of increased taxes, and differences between his administration and the legislature are reported to be “narrowing in scope.”
Lawmakers intend to be in session from now until the end of the month. If they succeed in passing the budget on time, they will likely recess for the remainder of the summer and return in the fall for a limited number of session days before the November general election.
Following is an update on recent legislative activity that is of interest to the Society.
he number of bills that have been introduced this session to address the current epidemic of opioid abuse facing the state continues to grow. Recently, a number of those bills have received action.
Senate Bill 1202, which passed the Senate unanimously on June 15, would require licensed prescribers and dispensers in Pennsylvania to complete two hours of continuing education in pain management or in the prescribing practices of opioids for licensure renewal. The education could be completed as a portion of the total continuing education required for biennial renewal, and it would not apply to physicians who do not possess a DEA registration number to prescribe controlled substances. House Bill 1805 is nearly identical to SB 1202, except that it requires the two hours of continuing education to be completed in pain management, identification of addiction, or in the prescribing practices of opioids. HB 1805 was approved by the House unanimously on June 23. The Pennsylvania Medical Society (PAMED) has expressed support for both bills.
HB 1698 and HB 1699 were also approved by the House on June 23. HB 1698 would require health insurance plans to provide coverage for abuse-deterrent opioids (ADOs) that are harder to crush, cut, dissolve or inject, and apply cost-sharing provisions for these products at the same level as cost-sharing applied to other brand and generic drugs covered under a plan’s formulary. PAMED supports this legislation.
HB 1699 would impose limitations on the prescribing of opioids within emergency departments and urgent care centers in Pennsylvania. It would limit prescribing to a quantity sufficient to treat a patient for seven days and any practitioner who violates this provision will have committed unprofessional conduct and be subject to penalties. The Pennsylvania Chapter of the American College of Emergency Physicians (PAACEP) and PAMED originally opposed the bill. However, both PAACEP and PAMED took a neutral position after the bills was amended to allow for exceptions to the seven-day limit if, in the professional medical judgement of the health care professional, more than a seven-day supply of an opioid drug product is required to treat the patient’s condition and there is a notation in the patient’s medical record.
Legislation will also be introduced in the near future that would require medical schools in Pennsylvania to implement mandatory Safe Opioid Prescribing Curriculum. State funding would be dependent on implementation of the curriculum, which would focus on four areas: pain management, multimodal treatments for chronic pain that minimize the use of opioids, identification of risk for addiction to opioids, and management of substance abuse disorders as a chronic disease. PAMED has not yet taken a position on the proposed legislation.
On June 23, members of the House of Representatives held a press conference in the Capitol Rotunda to call on Gov. Tom Wolf to call a special session of the General Assembly to combat the opioid crisis. So far, there have been nearly three dozen bills introduced to address this issue. Gov. Wolf has also made it one of his own priorities to provide a $34 million appropriation to create 50 Centers for Excellence across the state to treat Medicaid recipients for opioid addiction. It is unclear whether the appropriation will be part of the final spending plan approved by the legislature in the coming weeks.
With a growing number of services being provided via telemedicine technologies, there is an obvious need for a set of safeguards and standards to support the appropriate coverage of and payment for telemedicine services in Pennsylvania. PAMED believes that patient safety and quality of care must be the guiding principles behind any use of telemedicine.
For several months, PAMED has been working with other stakeholders to draft legislation addressing the use of telemedicine in Pennsylvania. Senator Elder Vogel (R-Beaver) is expected to soon introduce a bill in the Senate, and Rep. Marguerite Quinn (R-Bucks) has agreed to introduce a companion bill in the House of Representatives. The legislation will define what telemedicine is, offer guidelines outlining who can provide telemedicine services, and provide clarity around insurance company reimbursement for these services.
In addition, legislation that would authorize Pennsylvania to join the Interstate Medical Licensure Compact passed the House of Representatives unanimously on June 15. At the time of this writing, HB 1619 awaits consideration by the Senate Consumer Protection and Professional Licensure Committee. The overarching purpose of the Interstate Medical Licensure Compact is to streamline the licensure process for physicians interested in becoming licensed in multiple states. HB 1619 is thus being promoted as a way to increase access to healthcare for individuals in underserved or rural areas and allow patients to more easily consult medical experts through the use of telemedicine technologies. PAMED has not taken a formal position on the legislation and Pennsylvania’s participation in the Compact.
CRNP Independent Practice
The Senate Consumer Protection and Professional Licensure Committee approved SB 717 on May 18. The bill was amended by the Committee to require nurse practitioners (NPs) to have a minimum amount of post-licensure experience under a collaborative agreement with a physician before they may practice independently. While well-intentioned, PAMED believes the logic of this amendment was flawed. The stipulation on independence requires just three years and 3,600 hours of practice experience, while completely lacking meaningful details. There is no required curriculum for the completion of those hours/years, no assurance of the quality of mentors and oversight, and – unlike the 3 to 7 years of heavily supervised residency training that a physician must complete – no accreditation or inspection of the “training” sites of NPs.
Requiring a minimum number of years or hours of work experience in an unstructured setting with highly variable experiential learning does not replace the expertise and support that comes with physician oversight. PAMED continues to strongly oppose the legislation and encourage physicians to reach out to their legislators and urge opposition to the bill.
PAMED strongly supports a physician-led, team-based approach to patient care, which emphasizes increased collaboration and integration among health care providers, rather than provider autonomy. With the complexity of our health care system ever increasing, patients need both physicians and nurse practitioners, coordinating care and sharing information for the benefit of the patients. The collaborative agreement serves to ensure that patients have direct access to a physician when their care requires a more highly trained professional. Eliminating this network of support would not only be contrary to proven concepts of team based medicine, but has the potential to jeopardize patient care.
For past Quarterly Legislative Updates, please click here.
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Call to Action: Urge Your Representative to Oppose CRNP Independent Practice
We need your help.
On the evening of July 12, 2016, the state Senate passed Senate Bill 717 – legislation that allows CRNPs to practice independently and eliminates the requirement that they collaborate with physicians – by a vote of 41-9. The bill now goes to the state House for its consideration.
In the coming weeks, we are confident that with your help, we can successfully stop SB 717 from becoming law.
The Pennsylvania Medical Society (PAMED) is asking all physicians to call or email their state Representative and urge their opposition to SB 717. Nurses are contacting their Representatives in large numbers to support this bill. The physician voice needs to be heard loud and clear to protect quality patient care and patient safety in Pennsylvania.
PAMED strongly opposes SB 717 and continues to support a physician-led, team-based approach to care, which emphasizes increased coordination and integration among providers, rather than provider autonomy. Eliminating the collaborative tie that currently exists between CRNPs and physicians is contrary to these proven concepts and would only serve to further fragment patient care.