Harrisburg Advocacy Update

Date:   October 31, 2022
To:      Amy Davis, DO, FACP, Chair
PA ACP Health and Public Policy Committee

From:  John Nikoloff, ERG Partners


Legislation – General Assembly Update

The House and Senate have finished their scheduled work for the 2021-22 session.  The Senate is only scheduled for one more day, November 15 and the House November 14-16, during which time they expect to hold caucus leadership elections.

Prior Authorization Reform Now Act 146 of 2022.

PA-ACP’s top priority this year was prior authorization reform legislation.  SB 225 passed on October 26 with a 199-0 House vote and 50-0 vote in the Senate.  It was signed into law on November 3, and became Act 146 of 2022.

Behind the scenes, the bill that finally passed was the byproduct of thousands of hours of negotiations, discussions, and entreaties from more than 30 stakeholder groups, as well as the Departments of Insurance, Health, Human Services and Drug and Alcohol Programs.

Other Health Related Bills passed this fall

Bills supported by PA-ACP that were signed into law include:

HB 220 – requires DDAP standards to prohibit a facility from denying addiction treatment to an individual solely on the basis of a negative drug test. Signed by the Governor 11/3, Act 101.

HB 1393 – defines drug paraphernalia to exclude fentanyl test strips as a means of preventing accidental overdoses. test strips which are possessed by those dealing in fentanyl would still be illegal. The legislation allows possession of test strips only for personal use to avoid overdoses.  Signed by the Governor 11/3, Act 111.

HB 1630 – gives the state Auditor General authority to audit, review PBMs in MA, CHIP programs where state tax dollars are involved. Also extends permanently the COVID-19 waivers for certain psychiatric, home health and prescriptive drug services.  Signed by the Governor 10/28, Act 98.

HB 2293 - requires Contract Health Care Service Agencies who provide temporary employment in nursing homes, assisted living residences and personal care homes to register with the Department of Human Services (DHS) as a condition of their operations.  Signed by the Governor 11/3, Act 128.

HB 2527 – Replaces naloxone with the term “opioid antagonist” in state Controlled Substance, Drug, Device and Cosmetics Act. Signed by the Governor 11/3, Act 135.

SR 352 - Resolution directs the Joint State Government Commission to study and report on specific data, calculations and mechanisms that DHS uses to determine the amount of MA capitation funding paid to drug & alcohol treatment providers.

SB 317 – Provides for expedited partner therapy and issuance of prescriptions or antibiotics for partners without examining them when treating STDs, and excluding a practitioner from liability.  Signed by the Governor, 11/3, Act 147.

SB 522 – requires the Department of Health to establish a statewide lead poison educational campaign, and encourages pediatricians to seek to test all children ages 2 and under for lead blood levels after evaluating risk factors.  The bill was amended at the last minute in the House to remove a mandated lead testing program and insert language giving parents the right to refuse testing of their children.  This is a harbinger of what we can expect in the future on virtually all health-related legislation. Signed by the Governor 11/3, Act 150

SB 1201 – requires insurance coverage of early prescription eye drop refills at 70% of the original prescription if within original prescription time frame.  This is in line with CMS guidance and an attempt to cover losses, leakage, spilling and maintain therapy. Signed by the Governor 11/3, Act 161.

Priority Bills that failed to pass

Two key pieces of legislation that were PA-ACP priorities for the 2022 session were left on the table at the end of October.  Telemedicine legislation stalled in the House Insurance Committee this fall.  And legislation to prohibit non-compete agreements in health care practitioner contracts (HB 681) was never brought to a final vote in the House.  Of interest is that in the last two weeks, Sen. Michele Brooks introduced her own non-compete prohibition legislation, SB 1358.

Court Venue Rule Changes

As noted elsewhere, the State Supreme Court on August 25 rescinded its 20 year old venue rule, now allowing trial lawyers to venue shop and file medical malpractice claims in any county of the state regardless of where the medical care occurs.  PA-ACP condemned the change and promised to seek remedies that could alleviate the expected damage from this change, including support of HB 2660, which would create a public referendum for a constitutional change that gives the General Assembly the authority to govern venue rules.

Rep. Donna Oberlander had previously introduced a bill, HB 1540, that addresses the exercise of personal jurisdiction (i.e. the power of a court to determine whether it can exercise power over the defendant based on the defendant's ties to the forum in which the court sits) in medical professional liability actions.

2023-24 Issues Ahead

Several issues will definitely be on the legislative agenda in 2023-24.  The venue issue is one, as are telemedicine and noncompete contract prohibitions.  CRNP’s press for independent practice will be back again and pharmacists nationwide are seeking both federal and state laws to allow them to expand their role, citing their impact on public health with the COVID-19 epidemic.

It's a virtual certainty that legislation will be introduced and considered relative to “medical freedom,” parental rights, and gender reassignment.  The entire realm of women’s health and abortion will also have champions and verbal opponents in both Chambers.

The required recertification of PA’s 2.5 million MA patients with the end of the PHE will be the focus of other legislative attention, particularly if the DHS decides to extend the time period for having those folks recertify to the CMS recommended full year.

Politics – Looking Ahead

A minimum of five state Senators and 43 members of the House will not be back in 2023-24, and more could leave due to losses or election to other offices.  Both chambers’ Appropriations Committee Chairs will be replaced as will several other members of leadership.  And in the House a dozen committee chairs will be gone at the end of session.  Leadership elections and committee assignments could dictate much of the health care related agenda for the next two years.  In the House, the Democratic chairs of Children and Youth, Education, Human Services, Insurance, Labor & Industry and Transportation will be new, and potentially six other chairmanships will open.  Fifteen Republicans in leadership or now committee chairs, including Aging and Older Adult Services, Children & Youth, Education, Human Services, and Professional Licensure, will be leaving,

Reminder of 2022 Successes

These issues were PA-ACP successes earlier this year:

  • Full MA funding for Academic Medical Centers.
  • Blocked legislation to expand scope of practice beyond training for CRNPs by supporting a pilot project in federal Health Professional Shortage Areas.
  • Extended COVID Waivers re licensing, telemedicine, prior authorization.
  • Legislation making telehealth for mental health outpatient oversight permanent.
  • Legislation conforming state ambulatory surgical center rules with federal regs.
  • Legislation expanding the ability of seniors to access PACE, PACENet programs, expanding the program to more than 20,000 additional recipients.