Legislative Updates

PAP Legislative Update

Session Dates for the 203rd Legislative Session for the General Assembly follow.
 
Session Days for the Senate are:
            December 16, 17, 18
 
Session Days for the House are:
            December 9, 10, 11, 16, 17, 18
 
PAP will be following a number of legislative and regulatory issues in the coming months. Of significant importance to PAP is Out-of-Network (OON) Surprise Billing. PAP, together with its national partner, the College of American Pathology (CAP), continue as active participants in the statewide medical professional coalition named “The Provider Coalition for Patient Access. The goal of this coalition is to enact a law to take patients out of the middle for those services they receive out of network and commonly referred to as “surprise billings.” 

Two items of immediate concern include:
 
The Pennsylvania Civil Procedures Rules Committee proposal to change rules that would determine appropriate venue in medical professional liability actions. Changes, if implemented, would expand the possible venues where medical liability action could be initiated and thereby changing the intention and success of the Medical Care Availability and Reduction Error (MCARE) Act of 2002. Comments and opposition to this proposed change are being accepted through February 22. PAP will provide updates and action alerts to membership. PAMED hosted a meeting on January 14, 2019 to discuss plans to engage all members on this issue. Please visit www.pamedsoc.org/venuerule for information and a template for submitting your comments.
 
The City of Philadelphia introduced a proposed “Gift Ban” ordinance in 2018 that would require registration of pharmaceutical manufacturer agents and certain other requirements and prohibit gifts by pharmaceutical manufacturers and their agents to health care practitioners. The legislation was introduced in an attempt to curb the opioid crisis in Philadelphia but could have long-reaching affects in creating barriers between physicians and their patients. The legislation, which passed first reading on December 6, 2018, was scheduled for a final passage and vote on December 13, 2018. The legislation was tabled by co-sponsor Councilman Bill Greenlee at the December 13, 2018 meeting. PAP anticipates this legislation being re-introduced when the City Council convenes after the New Year.

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A Look Back at the 2017-2018 Legislative Year
 
During the two-year session, 3,953 bills were introduced by the General Assembly with approximately 6 percent (246 bills) passed and signed into law by the end of the session year. Over 80 pieces of legislation were passed in the final days of the two-year session.
 
The Pennsylvania Medical Society (PAMED) tracked approximately 259 bills that directly affected physicians and the house of medicine. PAMED provided the following review of their advocacy efforts on behalf of physicians throughout the Commonwealth and their anticipated efforts moving into the 2019 legislative session.
 
Scope of Practice Issues
Senate Bill 668 would have allowed optometrists to perform ocular surgery, treat systemic diseases, and order imaging tests. PAMED and other specialty societies supported the Pennsylvania Association of Ophthalmology (PAO) in opposition of the bill. SB 668 did see passage on the Senate side late in the legislative session but did not move to the House side for consideration.
 
Physician Assistants legislation (SB 895 and SB 896) was introduced that would have changed the patient record review process, the composition of the State Board of Medicine and the State Board of Osteopathic Medicine and the supervisory/written agreement between physician assistants and physicians. PAMED went on record in opposition of both bills. Neither bill was brought before a committee for vote and did not see any action beyond introduction of the bills.
 
CRNP Independent Practice Legislation was introduced in both chambers (House Bill 100 and Senate Bill 25) that would eliminate the current requirement for CRNPs to collaborate with physicians in order to diagnose, treat, and prescribe drugs to patients. Passage of this legislation would have permitted CRNPs to practice independently of physicians without the safety net of a collaborative agreement. At the end of the session, neither HB 100 or SB 25 were brought up for consideration.
 
Credentialing and ASC Tax
Former Representative Matt Baker introduced legislation (HB 125) that would have standardized the credentialing process for health care practitioners in the Commonwealth. All health insurers licensed to do business in the Commonwealth would be required to accept the CAQH credentialing application or other nationally recognized form designated by the Pennsylvania Insurance Department. Supported by PAMED and specialty societies, the bill would have required health insurers to issue a credentialing determination within 45 days after receipt of a complete credentialing application. HB 125 did pass the House (190-0) but was not successful in passing out of committee in the Senate.
 
Governor Wolf attempted to include a three percent (3%) tax on Ambulatory and Endoscopy Surgical Centers’ net patient revenue in his budget. Efforts by many specialty societies to oppose this proposed tax assessment resulted in the tax not included in the final state budget. PAMED supported the efforts of the specialty societies.
 
Opioid Legislation
Dozens of bills were introduced during the legislative session aimed at combating the opioid epidemic and heroin abuse crisis. A number of those bills were identified by the Governor and legislative leaders as priorities and acted upon before the end of the session.
 
House Bill 353 sought to include an e-prescribing mandate for Schedule II-V controlled substances. PAMED and specialty societies lobbied for several exceptions to the legislation including emergency situations, temporary technological malfunctions, lack of access to the Internet/HER system, and direct administration by a physician.
 
Act 96 was signed by the Governor on October 4, 2018. Physicians, pharmacy, or health care facilities that do not meet one of the exceptions in Act 96 and is unable to timely comply with the electronic prescribing requirements may petition the Department of Health for an exemption from the requirements based upon economic hardship, technical limitations, or exceptional circumstances. The exemption, based on rules established by the Department on the form and specific information required for the exemption, may not exceed one year from the date of approval, however, it may be renewed annually upon request and approval  Additional exemptions may be established by the Department through the regulatory process. Act 96 will not take effect until October 24, 2019. PAMED advises physicians to not wait until next fall to begin preparing for the e-prescribing requirement.
 
Senate Bill 655, also introduced during the 2017-2018 session, would have created an Advisory Council within the Department of Health that could mandate physicians follow guidelines, such as the current voluntary guidelines, when prescribing opioids. PAMED and specialty societies oppose legislation that would force physicians to practice “cookie-cutter” medicine. PAMED urged House members to oppose SB 655 and focus on the more immediate need of increasing funding and access for those who need treatment for opioid use disorder. The Senate unanimously passed SB 655, but the bill was never voted on in the House.
 
PAMED and The Hospital and Healthsystem Association of Pennsylvania (HAP) opposed House Bill 1987 which would have limited the use of fentanyl to surgery within a health care facility or to a hospice patient. Concern was expressed over appropriate use of the drug in clinical settings and preventing patients from receiving appropriate care. Lobbying efforts by specialty societies, PAMED and HAP were successful in amending HB 1987 to include “chronic pain not associated with cancer”. The bill was voted on favorably in the House but saw no action from the Senate Health and Human Services Committee or on the Senate floor.
 
Strong lobbying efforts by specialty societies and PAMED resulted in advocating for bills that did not infringe on physicians’ ability to address individual needs of their patients. Working with legislative leaders and their staff ensured legislation signed into law was clinically sound and in the best interest of patient care.
 
Lyme Disease
Legislation introduced in both the House (HB 174) and Senate (SB 100) would have required insurance coverage for Lyme disease and related tick-borne diseases as prescribed by a patient’s health care practitioner, regardless of whether the treatment plane included short-term or long-term antibiotic treatment. Neither bill made it out of committee for voting.
 
House Bill 2301 would have established a licensing board require a licensee complete at least two hours of continuing education in assessment, diagnosis, and treatment options for Lyme disease and other tick-borne related diseases as a portion of the total continuing educational requirements for licensure renewal. The bill, introduced in April 2018, saw no movement in either the House or Senate.
 
In attempting to respond to constituent concerns about treatment protocols and insurance coverage, the issue of Lyme disease will continue to evolve into the new legislative session. PAMED expects to see additional legislation introduced.
 
Sunscreen in Schools
The Pennsylvania Academy of Dermatology was supported by other specialty societies and the PAMED in advancing legislation (HB 1228) to allow students to have sunscreen at school in order to apply and reapply as needed for recess, field trips, sporting events, and other extracurricular activities. Governor Wolf signed Act 105 into law on October 24, 2018 with an anticipated effective date of December 23, 2018.
 
Telemedicine
Specialty societies and PAMED were engaged in a number of legislative efforts to pass telemedicine legislation. Two bills (SB 780 and HB 1648) were introduced and would have established a statutory definition for telemedicine, mandated reimbursement of telemedicine services, and prohibited “audio only” services (video available if requested by the patient or provider). Passage of telemedicine legislation would have provided access to health care in the most vulnerable populations (remote areas, urban communities that lack reliable or affordable transportation, patients with significant mobility challenges that present a barrier to in-person consultations). In June 2018, SB 780 passed the Senate unanimously (49-0). It appeared momentum to pass this legislation in the House was positive, however, 26 amendments were added to the bill in September and October. These amendments ultimately slowed the legislation to a grinding halt. Although not signed into law, it did pass a chamber for the first time since introduction.
 
POLST
Pennsylvania Orders for Life Sustaining Treatment (POLST) legislation passed the Senate (47-1) and would have created a legal framework for directives and ensuring a patient’s wishes for end-of-life care followed the patient across health care settings. As part of a multi-year collaborative effort of nearly 30 health care and patient advocacy organizations, the bill’s goal of easing the difficult clinical decisions patients and their family members encounter when end-of-life circumstance present themselves was strongly supported. The bill unfortunately did not make it through the House, but it did pass a chamber for the first time since its initial introduction more than five years ago.
 
Patient Test Results
Representative Marguerite Quinn introduced legislation (HB 1884) that would require an entity performing a diagnostic imaging service to send the results not only to the ordering physician but to directly notify the patient or the patient’s designee that the results were sent to the ordering physician when a significant abnormality is detected and follow-up with the ordering physician is recommended. Act 112 was signed into law by Governor Wolf on October 24, 2018. PAMED has reached out to the Department of Health to seek clarification on several issues of Act 112 (specific requirements, who is subject to the Act, and the Department will implement the law). It is recommended that physicians and facilities, in the interim, start discussing policy development with their in-house counsel, malpractice carrier or other applicable legal counsel for further guidance in implementing Act 112.
 
Pennsylvania Professional Liability Joint Underwriters Association (JUA)
Governor Wolf and the legislature has attempted to transfer more than $200 million from the Joint Underwriters Association (JUA) to the Commonwealth’s General Fund to subsidize the budget. In late December, a U.S. District Court blocked the Commonwealth of Pennsylvania from taking the fund from the Pennsylvania Professional Liability Joint Underwriting Association (JUA). Pennsylvania Medical Society President Danae Powers, MD, noted the landmark decision keeps alive a stabilizing force in Pennsylvania’s medical liability insurance market – protecting physicians in high-risk specialties and the patients they serve. The Court ruled Act 41 of 2018 violates the Takings Clause of the Fifth Amendment of the U.S. Constitution. In January, shortly after returning to the Capitol, Legislators filed an appeal of the December decision. PAP will keep you updated on the appeal process as additional information becomes available.