Pennsylvania Medical Society Quarterly Legislative Update
March 28, 2018
Prior Authorization Reform
The Pennsylvania Medical Society (PAMED) is advocating for reforms to the prior authorization process. We continue to urge affected physicians and their patients to file complaints with the Pennsylvania Insurance Department, contact their State Representative in support of HB 1293, and share patient stories at www.pamedsoc.org/PriorAuth.
Please note: The Pennsylvania Insurance Department does not have jurisdiction over, and therefore cannot investigate, self-insured plans as a result of the Employee Retirement Income Security Act of 1974 (ERISA). The Pennsylvania Insurance Department can investigate complaints from most other insurance plans.
PAMED is hopeful that the House Insurance Committee, where HB 1293 currently awaits consideration, will take some action on the measure in the near future. Now more than ever, it is imperative that all PAMED members push for this legislative change, which aims to increase transparency and standardization and improve response times with prior authorization.
Recently, this issue has gained increased attention due to a CNN story outlining details of an investigation into Aetna, where a former medical director admitted under oath that he never looked at patients’ records when deciding to approve or deny care. The Scranton Times also ran an editorial titled, “Stop insurers from dragging feet on care,” which ran in all the Times-Shamrock family of newspapers.
PAMED has used the media activity as a springboard, writing a letter to Acting Insurance Commissioner Jessica Altman urging her to review all licensed insurers and their prior authorization processes, and writing to the full House of Representatives urging their support of HB 1293.
In March, Gov. Tom Wolf removed prior authorization requirements for opioid treatment under Medicaid. PAMED applauds Governor Wolf for recognizing negative consequences prior authorization can have on this population of patients.
In a June 2017 ruling, the Pennsylvania Supreme Court held that, under the MCARE Act, the duty to obtain a patient’s informed consent is a non-delegable duty. Under the MCARE Act, except for emergencies, physicians must obtain informed consent from their patients, or their authorized representative, prior to conducting the following procedures:
- Performing surgeries (including the related administration of anesthesia)
- Administering radiation or chemotherapy
- Administering a blood transfusion
- Inserting a surgical device or appliance
- Administering an experimental medication
PAMED’s legal and government relations team have been working with the Hospital and Healthsystem Association of Pennsylvania (HAP) to draft legislation that aims to address physician concerns with this ruling. Stay up to date and get member-only resources at www.pamedsoc.org/InformedConsent.
Team-Based Care and Scope of Practice
On April 26, 2017, passage of SB 25 occurred in the Senate. As of the writing of this update, SB 25 is awaiting consideration by the House Professional Licensure Committee, as is HB 100.
Both SB 25 and HB 100 would grant independent practice to certified registered nurse practitioners (CRNPs). PAMED strongly opposes any legislation that does not keep physicians as the leader of the health care team. It’s a matter of patient safety! Learn more at www.pamedsoc.org/TeamBasedCare.
A roundtable discussion was held on Jan. 24, 2018, at the State Capitol and featured a panel of physicians and CRNPs. The focus of the discussion was to educate House Professional Licensure Committee members about the nature of collaborative agreements.
On the national level, a day-long meeting to develop a consistent strategy regarding scope of practice issues was held on March 20. The meeting at American Medical Association (AMA) headquarters in Chicago included representatives from state and specialty societies nationwide.
The AMA and others in attendance, including PAMED staff, shared resources and ideas that are available to societies as we continue to develop successful, consistent strategies.
Opioid Abuse Crisis
More than 25 pieces of legislation regarding opioids have been introduced. Legislation ranges from Prescription Drug Monitoring Program (PDMP) requirements to prescribing limits. PAMED is committed to ensuring legislation preserves the physician/patient relatonship as well as allowing for the physician to treat their patient appropriately.
Though there are quite a few pieces of legislation regarding opioids, PAMED is highlighting HB 353, which has the potential to affect many members. The bill has seen final passage in the House and is in the Senate Health and Human Services Committee as of the writing of this update. This legislation seeks an e-prescribing mandate for Schedule II-IV controlled substances, unless an exception applies. Emergency situations, temporary technological malfunctions, lack of access to the Internet/EHR system, and direct administration by a practitioner are listed as exceptions. Due to the exceptions for physicians without EHR systems, PAMED is neutral on this legislation.
Maintenance of Certification (MOC)
As a result of House of Delegates policy established in the fall of 2017, PAMED is drafting legislation that would prohibit health insurers and hospitals from using MOC as part of their credentialing criteria. The language will also prohibit the physician licensing boards from using MOC as a condition of licensure.
On Feb. 5, 2018, PAMED Past President Charles Cutler, MD, MACP, an internal medicine physician from Norristown, was one of 26 members chosen from a pool of nearly 200 applicants from 42 states for the new Vision Initiative Commission. The initiative, first launched in September 2017, was created to foster a collaborative dialogue across a variety of stakeholder groups. The Commission will then present its recommendations and findings to the American Board of Medical Specialties (ABMS) and 24 Member Boards for their consideration.
PAMED is committed to and will continue to advocate for practical, evidence-based, and affordable life-long learning. Learn more at www.pamedsoc.org/MOC.
Two bills – SB 780 and HB 1648 – would establish a statutory definition for telemedicine, mandate that telemedicine services are reimbursed, and prohibit “audio only” services (video must be available if either the patient or provider requests it).
PAMED remains optimistic that the General Assembly will ultimately pass a comprehensive telemedicine bill during the current legislative session. On behalf of physicians who utilize telemedicine, PAMED’s government relations team, along with HAP, will continue to advocate for this critical piece of legislation.
Under current law, insurers are not required to provide practitioners with drug alternatives when a drug prescribed by a practitioner is denied for not being in the patient’s insurance drug formulary. As a result, practitioners must expend time and resources to figure out what alternatives are available as part of a patient’s insurance coverage. PAMED’s Government Relations staff are working to hold meetings with lawmakers on this topic to identify sponsors and co-sponsors of legislation that would reform the drug formulary process to provide alternatives at the time of prescription denial.
PAMED’s annual Advocacy Day is scheduled for Tuesday, May 22, at the State Capitol in Harrisburg. Let your voice be heard and talk to legislators about important issues. PAMED members are encouraged to participate. Learn more and register at www.pamedsoc.org/AdvocacyDay.
Gov. Tom Wolf’s 2018-19 state budget proposes a 2.81% provider tax on ambulatory surgery centers (ASCs) and endoscopy centers to generate $25 million on an annual basis. The tax is proposed as part of the Human Services Code to provide additional dollars for Medical Assistance. PAMED supports specialty societies in opposing this tax by urging members to contact lawmakers to oppose, stating that this tax will drive up health care costs and put surgery centers at risk of closing.
A Look Ahead
Session: We can expect that the budget will take up a great deal of legislative time during the reasonably limited number of days the legislature is in session between now and June 30. The schedule is not unusual, as this is a very busy election year.
Elections: The Governor’s race has three GOP candidates heading into the primary race on May 15. The entire House and 50 percent of the Senate are up for election.
Register to Vote: April 16 is the last day to register to vote before Pennsylvania’s Primary Election on May 15. Visit www.votespa.com for additional information, including applications for absentee ballot, polling place location, and voter registration. Voting is important to help ensure that your voice as a constituent, and as a physician, is heard.