As a result of split control of the state’s two legislative chambers and the razor thin 102-101 Democratic control in the state House, the state budget and codes bills have still not been finalized, and that outside of the budget, only six bills have become law this session. House members have introduced more than 1,900 bills and resolutions, and state Senators have introduced more than 1,000. ERG is now tracking 725 separate bills and cosponsorship memoranda that would impact PA ACP members, practices and patients, and is directly and currently engaged in efforts to move or amend 19 different bills.
The House and Senate have been in session on alternating weeks multiple times this year, and that has happened in September as well. The Senate did return for one day of session on August 30 and sent a pair of budget-related bills to the House, and again the week of September 18, but those budget related bills are uncertain to get approvals in the House as they stand.
Senate Republican leaders acknowledged that some of the language includes “non-controversial” provisions that the House should be able to pass. But all are aware that the major code bill, HB 1300, amended by the Senate to include the PASS school voucher program and other programs that Senate Republicans insist are a priority for their caucus is not likely to get House Democrats’ vote.
The State Senate approved House Bill 1300, the fiscal code bill, by a 29-18 vote with two Democrats – Lisa Boscola, D-Northampton, and Anthony Williams, D-Philadelphia – joining with Republicans in support of the bill.
House Democrats response was, “A fiscal code is not an opportunity to renegotiate the budget. Since House Democrats passed the Senate’s budget in July, we have repeatedly tried to work to arrive at an agreement. Unfortunately, the Senate Republicans’ actions today do not advance the conversation toward finalizing the state’s budget in its entirety.” But Senate Majority Leader Joe Pittman said he and House Majority Leader Matt Bradford have not sat down together to discuss possible areas of agreement.
The House has been split evenly with Democrats and Republicans both holding 101 seats, and the Democrats have had no guarantee of keeping the majority if a vote was called, despite the rules they put in place in February.
Looking ahead this fall, the House and Senate have four weeks each scheduled for work before the election.
The only bill that we have engaged in that’s become law since early June is SB 262 which provides for a maternal mortality review committee and data collection. It passed the Senate and House unanimously and was signed into law as Act 5.
A number of other bills, however, are moving through the process with PA-ACP support or opposition;
HB 78, sponsored by Rep. Arvind Venkat, which would establish a Medical Debt Relief Program in the state, passed the House in June by 114-89 vote and is in the Senate Health and Human Services Committee. PA-ACP supports this bill
HB 106, which creates nurse staffing limits for health care facilities, passed the House by a 119-84 vote. PA-ACP opposed the bill because it would create significant issues for rural hospitals and require closing floors and departments if they could not meet the state-mandated ratios. This bill was a priority for the state’s unions. It’s now in the Senate Health and Human Services(HHS) Committee.
HB 807, which requires the DOH to partner with providers to educate women on perimenopause and menopause and provide informational materials. This bill passed the House 106-97 and is in the Senate HHS committee.
HB 817, which requires the Pharmacy Board educate licensed pharmacies on modifying their DEA registration and to receive and destroy prescriptions. The bill passed 102-101 and is in the Senate Consumer Protection and Professional Licensure Committee.
HB 1050, which requires state insurers to cover without co-pays provision of preventive health services as provided for in USHRSA guidelines – these were covered during the COVID-19 emergency, but would no longer be mandated after 12-31-23. The bill passed the House 199-4 and is in the Senate Banking and Insurance Committee. PA-ACP helped draft and supports this legislation.
The Shapiro Administration and Insurance Department are considering changes to the state’s Essential Health Benefits Benchmark Plan as part of its consideration of Rep. Boyle’s proposal.
HB 1184 allows PACE and PACENet to cover individuals if their income passes the guidelines if the increase was due to Social Security COLA increases. The bill passed House199-0 and is in the Senate HHS Committee. PA-ACP supports this provision.
SB 607 is similar to HB 1184 and extends eligibility to be maintained in PACE, PACENet if income ceiling is reached via Social Security COLA increases through 2025. It passed the Senate 50-0 and is in the House Aging and Adult Services Committee. PA-ACP supports.
SB 81 allows EMS providers to leave naloxone with the on-scene caregiver of a patient who overdosed on opioids as long as the DOH has a standing prescription. The bill passed the Senate 49-0 and is in the House Human Services Committee.
SB 414 is meant to expand hospital availability of SANE programs and directs DOH to make grant funding available to support delivery of sexual assault nurse examiner services. This passed the Senate 48-0 and is in the House Health Committee. PA-ACP supports this bill.
SB 683 would require hospitals to include fentanyl in drug toxicology testing during diagnosis of a patient’s condition. It passed the Senate 50-0 and is in the House Health Committee.
Other Legislation of Interest/Under Consideration
We have been working with House Insurance Committee chairman Kevin Boyle to develop legislation that would eliminate step therapy requirements for mental health medications. We expect a bill to be introduced this fall, and when it is, PA-ACP will support the legislation.
The House Professional Licensure Committee recently held a hearing to consider HB 1000, which would permit psychologists to qualify and prescribe drugs and controlled substances in collaborative agreements with providers under the supervision of the Board of Psychology. PA-ACP opposes this expansion of scope of practice and has joined with other medical professional organizations to do that.
Another option for increasing access to mental/behavioral health care that may well get consideration is the collaborative care model, as incorporated in SB 445 and HB 24. These bills propose a model care team that is led by a PCP and includes a consulting psychiatrist and behavioral health care manager. The PA Chapter of the American Psychiatric Association supports this concept and has asked PA-ACP to join it in that support.
Discussions continue on telemedicine legislation, and telemedicine is being included in many other bills, ranging from dentistry to mental health, behavioral health, SUDs, contraceptive care and psychology, as noted above. Leadership in the House and Senate have made it clear that they are willing to mandate coverage, but not payment levels at parity with office visits.
The expansion of ACOs and the continuing market battle between UPMC and Allegheny Health Network in western PA have accented issues of physicians being unable to leave an employer without leaving patients and the region. As a result, noncompete contracts legislation is getting support, even without the PAMed and HAP amendments inserted last session that provided many exceptions.
SB 521 and HB 1633 each declare noncompete covenants as void and unenforceable but under different circumstances. HB 1633 deems all new covenants and amended covenants null and void, and those amended or renewed prior to passage would be unenforceable on renewal of a practitioner’s license, registration or certification. SB 521 provides that noncompete contracts would be unenforceable only if a practitioner is dismissed. PA-ACP supports HB 1633, which incorporates our existing policy, but is willing to support amendments that protect groups investments through recouping expenses from employed physicians who choose to leave contracts with their patients before the term of their contract.
At this point, the only bills which have been put on key committee agendas are for a September 27 meeting of the House Health Committee. Those health related bills include:
House Bill 1417 reinstates coverage for dental care under the Medical Assistance program, which PA-ACP supports And House Bill 1585 which regulates tele-dentistry and provides for insurance coverage of tele-dentistry, and again PA-ACP supports the bill.
A hearing was recently held by the Committee on HB 1657 which effectively would eliminate all exemptions to smoking and vaping in public places. Interestingly, the bill would also eliminate exemptions for some outdoor facilities and in all workplaces – defining workplace to include a private home or residence if someone works remotely.
Legislation similar to HB 599 of last session (frozen formulary bill), which would bar insurers from changing formularies during the term of an insured’s contract is being drafted for consideration. But requirements under the Affordable Care Act may make it impossible to get serious consideration as decisions by CMS and FDA are now done under the act on a rolling basis. PA-ACP supports this legislation.
We expect to see some action on additional areas of concern, especially drugs and mental/behavioral health issues, but knowing what may move could be dependent on future discussions among the House, Senate and Governor’s Office. Other issues, including mandates for coverage of biomarker testing are also under consideration for legislative action.
PA-ACP is also working on moving legislation to speed up the credentialing and licensing processes, and is asking members to provide information on local or regional issues for use in a coalition effort from medical practitioner groups. Similarly, PA-ACP joined with a coalition of provider groups to ask Governor Shapiro to establish a health care workforce task force to explore ways to meet demands for health care workers across the state.
The Chapter is also working with the General Assembly and the Shapiro Administration to find a solution that allows Pennsylvania to join the Interstate Medical Licensure Compact. Prior efforts were unsatisfactory to the FBI, but to this date, the agency has not fully explained its issues with the Pennsylvania law.
The Chapter continues to seek a solution to the venue changes made by the Supreme Court which are already impacting medical malpractice filings and insurance premiums. This summer, PA-ACP signed onto a formal request to the Supreme Court’s Civil Procedural Rules Committee to conduct an immediate review of the impact of the medical liability venue rule that returned forum shopping to med mal cases. Plans are also being developed to move or amend legislation to give County Courts of Common Pleas jurisdiction over venue, and to seek further changes in legislation impacting med mal filings to establish liability and fair share settlements (joint and several liability.)
MA Fee Schedule Changes
The PA Department of Human Services (DHS) announced changes to the Medical Assistance (MA) Program Fee Schedule, effective on and after Sept. 5. The department is adding and end-dating procedure codes according to the 2023 updates provided by the Centers for Medicare and Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS).
Medicaid recertification is ongoing, and in the first three months, according to the Kaiser Family Foundation analysis of state data, 377,089 enrollees renewed their coverage and 184,758 enrollees were disenrolled, including 104,242 who were determined ineligible and 80,516 who were disenrolled for procedural reasons. Of those disenrolled, 46,289 were children and 138,568 were adults. Total MA/CHIP enrollment declined from 3.708 million in April to 3.653 million in June.
Politics and Elections
As a result of a special election in Allegheny County September 19, with the election of Lindsey Powell to the House, Democrats again have a majority of 102-101 in that chamber. The Senate remains 28-22 Republican control. The House has had six special elections already this year.
With the House at 102-101, other vacancies could change the complexion of the General Assembly and action on many legislative fronts. Rep. John Galloway is expected to be elected to a county judgeship in Bucks County in November and will have to resign his House seat to take that position. His district is a relatively competitive district and it’s conceivable the Republicans could win the seat, switching control of the House. Three other Democratic members – Reps. Malcolm Kenyatta who is running for state Auditor General, Joe Hohenstein of Philadelphia, running for state Attorney General, and Jared Solomon of Philadelphia, running for Auditor General, will have to vacate their seats if successful. All three represent districts with significant Democratic registration edges. Other members may well seek higher office in 2024 as well.
Supreme Court Election November 7
Voters will choose Pennsylvania’s newest state Supreme Court justice during the general election on Nov. 7. Democrat Daniel McCaffery and Republican Carolyn Carluccio are looking to round out the seven-member court.
The race will not change partisan control of the court, which currently has a 4-2 majority of judges elected as Democrats, with one vacancy. Notably, four of the justices currently on the Court are trial lawyers, and consistently side with plaintiffs; they were responsible for peeling back venue reform and cutting into other med mal reforms.
Republicans are hoping to fill this seat now with a judge who has not supported these changes, and to be in position to reform some of these tort/med mal issues in future years. All four incumbent Democratic justices either face retention or reach mandatory retirement age by 2027.