August 8, 2024: Summer 2024 Advocacy Update
HARRISBURG UPDATE
With the state budget and codes bills passed for 2024-2025, the Senate has adjourned until September 16 and the House is adjourned until September 23, leaving only a dozen potential days of voting session remaining this year prior to the November 5 elections. Given the normal pre-election atmosphere and the split control of the House and Senate, any legislation that gets passed this fall will have to be a compromise or an agreed-to bill with significant majority support in both chambers.
In the days after the House recessed for the summer, two Democratic members from Philadelphia, Human Services Committee Chair Stephen Kinsey, and Children and Youth Committee Chair Donna Bullock, resigned, leaving the House temporarily with 100 Democrats and 101 Republicans. But due to a rule passed by the then-majority Democrats earlier this session, they maintain control of the House until they come back into session. Speaker Joanna McClinton has scheduled special elections for those seats for September 16, and the House is not scheduled to return until September 23. It’s expected the two seats will remain Democratic.
In this memo, we’ve outlined a general summary of the budget, and legislation impacting PA-ACP members that were passed and sent to the Governor, legislation that we were able to prevent, and a list of bills that passed one chamber this spring. We’ve also attached a breakdown of health-related matters included in the state Fiscal Code bill for the coming state fiscal year.
PA-ACP has continued to be actively engaged in lobbying efforts at the Capitol, and with the Shapiro Administration. ERG Partners and its four lobbyists have been in leadership roles in securing passage of several key priority bills for internists across the state this spring and through budget session.
LEGISLATION PASSED
Several significant bills were passed this spring, with major victories in getting legislation to ban noncompete clauses in health care provider contracts, mandates for telemedicine coverage and resolving the Interstate Licensure Compact problems with the FBI.
Below is a list of the bills of interest to PA-ACP that were signed by the Governor in late June and early July:
HEALTH RELATED LEGISLATION SIGNED
HB 1754 (Act 41) – mandates coverage of biomarker testing
SB 739 (Act 42) – mandates coverage of telemedicine
HB 1664 (Act 58) – requires insurers to make options besides credit card payments available to providers
HB 1633 (Act 74) – bans noncompete clauses in health care provider contracts; we were successful in amending this to eliminate multiple exceptions.
HB 1993 (Act 77) – Regulates PBMs, including audits, issues, drug pricing and availability. Amendments to the bill allow pharmacists to conduct immunizations injections and biologicals for children 8 and above, and 5 and above for COVID-19 and flu.
HB 2200 (Act 79) - Interstate Compact legislation.
SB 559, (Act 83) and SB 560 (Act 84) – Allow athletic directors to perform certain invasive procedures on physically active persons, with written protocol from a physician.
HEALTH RELATED LEGISLATION WE OPPOSED THAT WAS BLOCKED
We were successful in blocking passage of three major scope of practice expansions:
SB 25 – CRNP Scope of Practice. Stakeholder discussions will now be held starting in early September and moderated by House Professional Licensure Committee Chair Frank Burns.
HB 1000 – Psychologists Scope of Practice to prescribe meds – Blocked in House
HB 2037 – Pharmacists to provide immunizations, injections, biologicals to all children 3 and up – Blocked in House.
PA-ACP has been asked to play a lead role on behalf of physicians in ongoing stakeholder discussions and negotiations over CRNP scope of practice legislation, with those discussions slated to begin in early September.
And the Chapter will also be leading health care providers’ coalition efforts to secure additional legislation to address the problems that the Court created by revoking the 20 year old venue provisions that were part of the med mal crisis solution in 2002-2003.
Other Legislation of Interest:
Minimum Wage – discussed with budget, but no agreements reached.
HB 731 – firearms, locking devices, safe storage – laid on table in House
HB 1018 – red flag legislation – passed House 102-99, in Senate Judiciary since June 2023
HB 1140 – mandate coverage of contraceptives–passed House 133-69, in Senate Banking and Insurance
HB 1425 – maternal visits – passed House 144-57, in Senate Health and Human Services
HB 1657 – Clean Indoor Air Act – laid on table in the House
HB 1685 – AEDs at athletic events –passed House 157-45, in Senate Education Committee
HB 2268 – mandate coverage for stuttering – passed House, in SENATE B&I
HB 2294, HB 2295 – PA’s can report to either allopathic or osteopathic docs – House Rules Committee
HB 2344 – Attorney General to review hospital, practice mergers and acquisitions – passed House 114-88, now in Senate Health and Human Services Committee
HB 2363 – Expands drug repository program – in House Rules Committee
HB 2381 – DOS temporary rulemaking for Interstate Compacts – passed House 177-25 and in Senate Consumer Protection and Professional Licensure Committee
SB 375 – CPR and AEDs in schools – 2nd consideration and now on table in Senate
SB 817 – FQCH primary care workforce initiative – in Senate Appropriations Committee
BUDGET
Eleven days after the constitutional deadline for a state budget, the House and Senate passed and Governor Shapiro signed a $47.6 billion general fund budget, $2.7 billion more than last year, with a 4.7% increase in spending. The House passed the budget bill (SB 1001) with a 122-80 vote, then the Senate concurred with a 44-5 vote.
The provisions now in the Fiscal Code (HB 2310) that impact Health and Human Services programs are attached. The budget also provides an additional $100 million for mental health programs. The medical debt relief proposal was not included in the budget dealings.
PA FISCAL CODE BILL HEALTH RELATED PROVISIONS – PASSED IN HB 2310
State Health Insurance Exchange Affordability Program
Establishes the Affordability Assistance Program (program) under the Pennsylvania Health Insurance Exchange Authority (authority) to incentivize enrollment in health insurance policies offered on the exchange. People purchasing a health insurance plan on the exchange shall be provided financial assistance to cover the cost of the insurance based off the individual’s adjusted gross income.
Creates the Exchange Affordability Assistance Account (account) within the State Treasury. Deposits money from the Joint Underwriters Association into the account.
State Reinsurance Program
Requires the Insurance Department (department) to apply for a waiver from the Federal Government to establish a reinsurance program and maximize federal funding for the reinsurance program.
Intermediate Care Facilities Assessment Extension
∙ Extends the assessment on Intermediate Care Facilities through June 30, 2029. The current authority sunsets June 30, 2024.
Philadelphia Hospital Assessment Reauthorization
∙ Makes changes to the assessment rate tiers as requested by the Centers for Medicare and Medicaid Services (CMS). Philadelphia City Council passed these updates in their corresponding ordinance as well.
∙ Extends the assessment through June 30, 2029. The current authority sunsets June 30, 2024.
Tobacco Settlement Fund and Debt Service
∙ Distributes the Tobacco Settlement Fund debt service transfer and the annual distribution from the Tobacco Settlement fund.
∙ Distributes money in the Tobacco Settlement Fund for fiscal year 2024‐2025 as follows:
⮚ 4.5% for tobacco use prevention and cessation programs under Chapter 7 of the Tobacco Settlement Act.
⮚ 12.6% for health related research under section 906 of the Tobacco Settlement Act; ▪ 70% to fund research under 908 of the Tobacco Settlement Act. ▪ 30% as follows:
∙ $1 million for spinal cord injury research programs under section 909.1 of the Tobacco Settlement Act.
∙ 75% for pediatric cancer research. No more than $2,500,000 in a fiscal year may be made available to any one pediatric cancer research institution.
∙ 25% for research grants for biomedical research institutions to research Amyotrophic Lateral Sclerosis, Alzheimer’s disease, Huntington’s disease, Parkinson’s disease and other neurodegenerative diseases, as
designated by the Secretary of Health.
⮚ 1% for health and related research under section 909 of the Tobacco Settlement Act;
⮚ 8.18% for uncompensated care payment program under Chapter 11 of the Tobacco Settlement Act;
⮚ 30% for the purchase of Medicaid benefits for workers with disabilities under Chapter 15 of the Tobacco Settlement Act; and,
⮚ 43.72% to be appropriated separately for health‐related purposes.
∙ Uncommitted funds for capital and equipment grants from fiscal years 2021‐2022 or 2022‐2023 shall be allocated equally to pediatric cancer research institutions that are equipped and actively conducting pediatric cancer research.
Department of Human Services (DHS) Restrictions and Reporting
∙ Requires that the department not add any non‐medically necessary services to the Medical Assistance program that would result in the need for a supplemental appropriation without the approval of the General Assembly.
∙ Requires the Secretary to report on a quarterly basis to all Appropriations Committee chairs on the status of Medical Assistance appropriations.
Budget Implementation
∙ Allocates $10,000,000 for rural hospitals participating in the Pennsylvania Rural Health Model to bridge between the expiration and a replacement through federal action to be finalized. (Dept. of Human Services)
∙ Allocates $21,000,000 for Day One Incentive payments to high Medicaid skilled nursing facilities. This is an increase of $5,000,000 over the previous fiscal year. (Dept. of Human Services) ∙ Specifies that there is sufficient money to provide a 7.04% annualized rate increase for skilled nursing facilities. (Dept. of Human Services)
∙ Allocates $7,500,000 to provide a rate increase to LIFE providers. (Dept. of Human Services) ∙ Includes standard budget implementation language carried annually to mirror calculations and other assumptions contained in the General Appropriations Act.