Bills on the Hill: Credentialing, Opioids, and Non-Compete Clauses

By Michael D.I. Siget, JD, MPA, PAMED's Legislative & Regulatory Counsel

With the new legislative session underway, a flurry of legislative activity has taken place. 

Part 1 of my "Bills on the Hill" will focus on credentialing, abuse deterrent opioids, criminal activity, retaliation and non-compete clauses. Part 2 will focus on electronic prescriptions, the PDMP, official state prescription forms, prescription limitations and CRNPs.

Mike-SigetHB 125, introduced by Rep. Matthew Baker, would provide for the use of a Council for Affordable Quality Healthcare (CAQH) credentialing application that physicians and health care providers would be required to use when seeking to become credentialed by a health insurer.

Provisional credentialing would be granted to eligible applicants if a health insurer failed to issue a credentialing determination within 30 days after receiving the completed form. Any services provided while the practitioner was under provisional status would be covered by the health insurer under the same terms as are applicable to participating health care practitioners in the applicant's provider group.

HB 125 was referred to the House Health Committee for consideration on Jan. 23.

HB 288, introduced by Rep. Doyle Heffley, would require insurance plans in the Commonwealth to provide access to abuse deterrent opioids (ADOs) if the plans provide coverage for at least one opioid analgesic drug product. The bill would also prevent health plans from implementing "step therapy or fail first" policies on these products.

HB 288 was referred to the House Insurance Committee for consideration on Feb. 2.

HB 317, introduced by Rep. Dom Costa, would amend the Medical Practice Act of 1985 to require the State Board of Medicine to permanently revoke the certification of a licensed practitioner for the conviction of an offense related to the theft of a controlled substance. A similar bill also has been introduced by Rep. Costa for Osteopathic physicians, HB 312.  

Both HB 312 and HB 317 were referred to the House Professional Licensure Committee on Feb. 3.

HB 339, introduced by Rep. Anthony DeLuca, would prohibit a health care facility from discriminating or retaliating against physicians and health care providers, staff at medical facilities or any citizen who submits a grievance or complaint to the facility or agency responsible for evaluating or accrediting the facility.

The prohibition would also apply to individuals who initiate, participate or cooperate in an administrative proceeding relating to quality of care, services or conditions at the facility. Where the facility did discriminate or retaliate, the legislation would provide civil and criminal penalties including assessment of a fine and restitution for lost wages, work benefits and the legal cost of having to pursue the claim of retaliation or discrimination. 

In addition, the bill would balance the needs of the health care facility by protecting legitimate peer review activities.

HB 339 was referred to the House Health Committee on Feb. 6.

HB 346, introduced by Rep. Anthony DeLuca, would prohibit the use of non-compete clauses in health care practitioner employment contracts for any contract entered into on or after the date this bill would become law. This bill would prohibit any restriction of the right of the practitioner to practice in a geographic area for a period of time after the termination of the employment relationship and would also prohibit any restriction on a practitioner from treating a prior patient. 

This bill contains an exception for buyout clauses that require a practitioner to reimburse an employer for reasonable expenses incurred in recruiting the practitioner and establishing the practitioner's patient base. However, a buyout clause would be void if it contained a term fixing unreasonably large liquidated damages or if the employer terminated the employment relationship actually or constructively.

HB 346 was referred to the House Health Committee on Feb. 6.

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