Last Updated: Jul 10, 2019
By Michael D. I. Siget, JD, MPA, PAMED’s Legislative & Regulatory Counsel
With the enactment of a state budget, several health-related bills saw movement prior to the General Assembly recessing for the summer.
In this Bills on the Hill Part 1, we highlight six bills that were signed into law. The new laws address the creation of a Pa. health insurance exchange, medication synchronization, license portability, state oversight of the Pennsylvania Professional Joint Underwriting Association (JUA), CPR instruction for high school students, and physician assistant (PA) supervisory agreements.
Part 2 of this Bills on the Hill blog looks at more than a dozen health-related bills that have passed one chamber of the legislature. Check it out here.
State-based Health Insurance Exchange
HB 3, introduced by Rep. Bryan Cutler, creates an authority to operate a state-based health insurance exchange for Affordable Care Act (ACA) individual market plans.
The legislation will also permit the Commonwealth to apply for a Section 1332 State Relief and Empowerment Waiver from the federal government to create a reinsurance program to drive down premium increases in the individual market. Section 1332 of the ACA authorizes states to pursue innovative strategies for providing residents with access to health insurance while retaining basic protections provided under the ACA.
This legislation will allow Pennsylvania to set up its own health insurance exchange, eliminating the need for the state to pay the federal government to run one of the state’s behalf.
HB 3 was signed into law on July 2, 2019 as Act 42-2019 and takes effect immediately. The Pennsylvania Department of Insurance says that the exchange is expected to be operational as early as Jan. 1, 2021.
HB 195, introduced by Rep. Eric Nelson, allows patients to synchronize their medications in order to receive them on the same day each month instead of having to make multiple visits to the pharmacy. This legislation includes protection for patients by barring insurance plans from denying coverage for prescriptions filled by medication synchronization on the basis that it is a partial fill of the prescription, while also providing for prorated cost sharing.
Medication synchronization occurs by allowing pharmacists to dispense partial quantities, or short fills, of the patient’s medications, in order to coordinate the prescription fill date with that of the patient’s other medications.
HB 195 was signed into law on July 2, 2019 as Act 46-2019 and takes effect on July 1, 2020.
HB 1172, introduced by Rep. David Hickernell, requires all the licensing boards and commissions under the Bureau of Professional and Occupational Affairs to issue licenses by endorsement, and further provides for a provisional endorsement license.
Prior to this bill, not all licensing boards had a process to issue licenses for out-of-state licensees through an endorsement process. Both state medical boards have an endorsement process (except for a provisional process), so not much is expected to change under the medical boards.
HB 1172 was signed into law on July 1, 2019 as Act 41-2019 and takes effect on Aug. 30, 2019.
Find more information about the License Portability Act here.
HB 1461, introduced by Rep. Mindy Fee, started out as a bill regarding enforcement authority by the Office of Inspector General. It was amended to include provisions giving the state oversight of the Joint Underwriting Association (JUA). The provisions relating to the JUA include:
- Requiring the JUA to submit a report of written estimates to the Secretary of Budget.
- Within 30 days of the submission of these estimates, an agent of the JUA will be required to appear before the Senate Banking and Insurance Committee and the House Insurance Committee to testify about the contents of that report.
- Requiring the JUA to annually appear before the House and Senate Appropriations Committee to testify as to the fiscal status of the JUA and make any requests for appropriations
- Requiring the JUA to hold quarterly public meetings to discuss the actuarial and fiscal status of the JUA.
In addition to these requirements, the JUA will be required:
- To submit a list of all JUA employees to the state.
- To be subject to the state’s Right-to-Know Law, the PENNWATCH Act, the Procurement Code, and Commonwealth Attorneys Act.
- To conduct all business in state-owned office buildings.
- To ensure that any employee of the JUA with access to Federal tax information has met all the requirements of the prerequisites of the Department of Revenue to gain access to that information.
HB 1461 was signed into law on June 28, 2019 as Act 15-2019. The part of Act 15 relating to the JUA took effect immediately.
You can read about prior events concerning the JUA in PAMED’s JUA Timeline of Events here.
CPR Instruction for High School Students
SB 115, introduced by Sen. Tom Killion, enhances CPR instruction for students in grades 9 through 12.
Specifically, this legislation requires the Pennsylvania Department of Education to consult with stakeholders knowledgeable in the content area to design model curriculum, age-appropriate materials, and guidelines for integrating CPR instruction into existing curriculum. Professional educators would be able to utilize these materials to deliver CPR instruction.
SB 115 was signed into law on June 12, 2019 as Act 7-2019 and takes effect on Aug. 11, 2019.
Physician Assistant Supervisory Agreements
SB 698 and SB 699, introduced by Sen. John Gordner, allow a physician to appoint a designee to assist in the online completion of physician assistant supervisory agreements through the Pennsylvania Department of State's (DOS) new online PALS licensing system. Physicians would still be required to review and approve the electronic submission of the agreement.
Supervisory agreements are currently submitted through a manual paper process. DOS will soon be transitioning to an online process utilizing PALS. Prior to the enactment of these two laws, the online process that was developed would have required physicians to personally enter supervisory agreements into PALS, as designees are not authorized to access PALS on a licensee’s behalf. The legislation now allows a designee, such as office staff, to assist in entering this information into PALS.
It is important to note that the new laws do not eliminate the requirement that physicians must review, and ultimately sign off on, any written supervisory agreements. They simply provide physicians with the same flexibility with the PALS system that they had with the previous manual submission process through DOS.
SB 698 (relating to MDs) and SB 699 (relating to DOs), were signed into law as Acts 68-2019 and 69-2019, respectively, on July 2, 2019. Both acts take effect on August 1, 2019.