Legislative Update: June 1, 2021
The legislative agenda is full and getting to overflow status quickly with the June budget session time approaching. Most of the bills passed by the General Assembly tend to be passed in June and during the last two weeks of every year. This year appears to be no different.
We have established policy on most of these bills, at least in concept. As things move forward, and as amendments jump up, sometimes with just an hour to respond, the PA-ACP Board of Directors has established a “Rapid Response” team comprised of the president of the 501 c (6), the Chair of HPPC and ERG Partners. When we have at least24 hours, the Governors are all polled on a given issue.
When we have more than a sufficient time on issues, we use a service called VoterVoice to email all members and ask their engagement by writing their State Senator or Representative though a one-click email setup. We are seeking to build up the number of Keystone Contacts, members who agree to serve as liaisons with their local elected officials to amplify these efforts.
There are several relatively new issues for discussion, notably vaccination bills, PAs scope of practice and extension of disaster order health care innovations.
The passage of the two constitutional amendments will mean a significant change in the future dealings of the Governor and General Assembly. Two days after the vote, the Governor extended his 90-day order through late August. And a week before that he extended (for the 12th time) his emergency order on a statewide opioid epidemic and responses to that. The votes won’t be certified until June 7, and depending on your legal viewpoint, that means the 21-day provision will kick in June 9.
It may be weeks till we see a real impact on medical practices, though. Most of the orders that changed telemedicine, prior authorization, etc. are orders from the Department of Health or Human Services under the state’s Disease Prevention and Control Acts, not contingent on the disaster declaration and orders.
That said, the Administration has started warning physicians that these flexibilities are coming to an end on several counts. Most recently, the Department of Human Services announced to the Medicaid Managed Care Organizations (e.g., UPMC, Geisinger, Heath Partners, Gateway, Aetna, United, Caritas/Keystone First/AmeriHealth) that the lifting of prior authorization requirements will go back to pre-pandemic operations as of July 1.
Negotiations have started between legislative leaders and the Administration, and this morning, House Majority Leader Kerry Benninghoff said the House would pass a resolution extending the order through September 30, but would curtail only certain provisions, like essential businesses, business closings, social distancing, etc.
The Senate has also moved a bill (SB 671) out of Committee that PA-ACP supported – this would extend waivers and administrative flexibilities for health care facilities and providers for one year after the end of the disaster emergency order. Hopefully, the bill will leverage discussions with the Wolf Administration, but it would extend telemedicine and payment equity for a year, along with some prior authorization, while we seek permanence of those bills.
It may be the middle of June until we can be sure what the next few months will bring. ERG Partners will continue to provide updates via email and the Chapter website.
CRNP Scope of Practice – The agreement reached among all parties last year was kicked rejected by the Nurse Practitioners Coalition in the new session. Sen. Camera Bartolotta, the prime sponsor of SB 25, which would give CRNPs independent practice statewide, is insisting the Senate Consumer Protection and Professional Licensure Committee move the bill to a vote in the Senate. PA-ACP has met with Senate leadership to oppose that action.
We have been fighting this issue for almost 20 years now, and like other scope of practice issues, it continues to be a top priority because of quality of care issues and a lack of evidence-based information to justify such action.
Telemedicine – Sen. Elder Vogel plans to reintroduce his bill regulating telemedicine – a bill that has also passed the Senate twice. Last year the bill was amended by the House to include REMS list language which included abortion pills. Governor Wolf vetoed the bill and promised to veto any legislation on his desk that limits abortion and family planning services. PA-ACP is continuing to seek legislation that expands the use of telemedicine and the benefits it has shown in management of chronic care, adherence to medication regimens, and mental health/behavioral health issues.
Non-compete Contracts – This legislation is being considered, with HB 681, sponsored by Rep. Torren Ecker, moved out of Committee in the House and now on the voting calendar. PA-ACP has been a strong supporter of legislation banning non-compete contracts for a decade. The bill was amended to add various provisions under which a health system could still use these clauses for two years within 45 miles in health care provider contracts. PA-ACP plans to support the bill and seek clarifications and amendments in the State Senate.
Informed Consent. SB 425 is legislation needed to avoid physicians having to explain and obtain informed consent of patients on treatments and procedures, a change mandated by a Supreme Court decision. The bill passed the Senate with PA-ACP support by a 47-0 vote, but amendments have been proposed in the House to limit delegation to other physicians and other provisions that would hold up its passage and/or kill the bill. We have written all members of the House asking them to pass SB 425 as approved by the Senate.
Prior Authorization. Prior Authorization reform is a PA-ACP priority, and the Chapter was an early leader in calling for this action. We are still negotiating over the language in HB 225/SB 225 as well, joined by all medical professional organizations, HAP and more than 50 patient/disease advocacy organizations in seeking this. We have recruited more than a dozen members of the House and Senate to become cosponsors this session.
A press conference was held Monday, May 24 by the coalition to draw media attention to the problems caused by current practices. At the same time, ACP is supporting national legislation on this issue, and in mid-May, a coalition of more than 70 health care organizations called on Congress to pass legislation that would protect Medicare Advantage patients from unnecessary delays in care and modernize the process of prior authorization. PA Congressman Mike Kelly from Erie is championing this new bipartisan legislation, which would add additional standardization, oversight and transparency in that process.
Other Scope of Practice Legislation. We have actively opposed other expansions for midlevel providers’ scopes of practice, including psychologists, physical therapists, optometrists, and pharmacists – most notably pharmacists, who have had legislation introduced to give them continuing authority to administer more vaccinations, injections, biologicals, and to adjust medications for patients.
Physicians Assistants are also pressing for changes in the regulation of their profession as well with SB 397 and SB 398, both sponsored by Indiana County Sen. Joe Pittman. These bills would increase the number of PAs a physician can supervise from 4 to 6 (eight in a hospital setting), eliminate the Bureau of Professional and Occupational Affairs’ review of agreements, and limit audits of countersignatures to a smaller percentage of charts. No provisions in these bills would limit PA’s ability to practice outside the scope of their supervising physician.
Medical Malpractice. This continues to be a huge pending issue, with the State Supreme Court still considering major changes to Med Mal laws passed in 2003-4 which have limited venue and the statute of repose for these suits. In late 2019, the Court announced that its Committee on Rules and Civil Procedures was considering tossing out a key compromise from 2003 that requires a med mal lawsuit be filed in the county in which the alleged malpractice occurred. We are seeking legislation to again clarify the intent of the General Assembly that lawsuits must be filed in the county where the alleged act occurs.
In addition, we continue to seek legislation that would grant limited civil immunity similar to Good Samaritan immunity to providers for actions taken during the Covid-19 pandemic. Bills including this immunity have twice been passed and vetoed by the Governor, because of additional provisions protecting various businesses.
PA-ACP has participated in two court cases on the Venue issue, as an amicus curia, and most recently, a Delaware County case was resolved in our favor, keeping the venue in Delaware County rather than moving the lawsuit to Philadelphia.
Pharmaceutical Transparency Act
Sens. Dan Laughlin (R-Erie) and Sharif Street (D-Philadelphia) and healthcare advocates have called for consideration of Laughlin’s SB 579, the Pharmaceutical Transparency Act, to begin the process of addressing soaring prescription drug prices. PA-ACP policy supports legislation to address these rising costs. SB 579 would create a Pharmaceutical Transparency Review Board tasked with reviewing drug prices and making recommendations for how to address affordability burdens. The proposed board would be composed of legislative leadership-appointed members who have backgrounds in health care economics or clinical medicine and are not connected to drug manufacturers. The Board could ask for pricing breakdowns from pharmaceutical companies or from other states who may have similar boards. PA-ACP is supporting this legislation.
According to a 2020 survey conducted by Altarum, more than half of all respondents reported being worried about being able to afford prescriptions. The nonprofit health research and consulting organization found that 1 in 5 Pennsylvanians had reportedly not filled a prescription, cut their pills in half or skipped a dose of medication in the last year, with as many as 28 percent of rural respondents reportedly skipping medication or splitting doses compared to 17 percent of nonrural Pennsylvanians.
The bill has received bipartisan support in terms of cosponsorship. It has yet to move from the Senate Banking and Insurance Committee after first being introduced in mid-April. PA-ACP testified in support of legislation to control drug costs, and has repeatedly supported legislation that would save patients money and increase compliance with drug regimens.
PACE/PACENET Eligibility. The Senate adopted legislation in May (SB 323) that would allow thousands of older Pennsylvanians to retain eligibility for prescription drug assistance if their Social Security COLA pushes them beyond income limits over the next two years. PA-ACP has supported other similar bills in the past.
PACE and PACENET provide medications to 257,000 seniors, with eligibility based on income. The Social Security cost-of-living adjustment (COLA) for 2021 is estimated to result in almost 17,800 PACE and PACENET cardholders exceeding the income eligibility limits, meaning those seniors will lose their benefits.
Vaccine Legislation. There are 30 bills now introduced or pending that would impact vaccinations, ranging from childhood vaccinations to Covid-19. These bills would variously expand the philosophical exemption to childhood vaccines, prohibit vaccine mandates as a condition of work, (HB 1439 and SB 471).
HB 958, “The Immunization Freedom Act,” sponsored by Rep. David Zimmerman of Lancaster County, was voted out of the House Health Committee and is on the tabled calendar.
The bill requires the Board of Medicine and the Board of Osteopathic Medicine to apply administrative penalties to a health care provider who requires patients receive vaccinations according to the CDC-recommended schedule for treatment or who requires that adult patients get vaccinated to remain under their care.
Prudent patient care would suggest these are not in the long-term best interest of the patient or the public. PA-ACP’s Health and Public Policy Committee has recommended the Chapter oppose legislation that interferes in the physician-patient relationship.
HB 1033, sponsored by Health Committee chair Kathy Rapp, would require insurers to reimburse for long term antibiotic and antimicrobial treatments if determined to be medically necessary by the health care provider. The bill also forbids licensing boards from taking actions against a health care provider for recommending a treatment protocol which the health care practitioner deems medically necessary. PA-ACP has always supported patient care that is supported by evidence-based data.