Last Updated: Dec 19, 2023
“Unpredictable” is probably the best word to describe the many changes that have taken place over the past year…both from a legislative perspective and a political one, although the two are often inextricably linked.
Shortly after the 2022 House of Delegates last October, the General Assembly approved Senate Bill 225, prior authorization reform legislation. This proposal was the result of nearly six years of stakeholder meetings, physician coalition discussions, meetings with PAMED physician leaders, and grassroots physician advocacy. The new law made changes to the time-frames health insurers have to make prior auth decisions, refined the definition of medical necessity related to prior authorizations, streamlined the process of medication step therapy, and enacted changes to the qualifications of peer-to-peer reviewers. Passage of Senate Bill 225 was applauded by physician organizations across the Commonwealth along with members of the legislature. Though more work needs to be done when it comes to the relationship between physicians, health insurers, and patients.
Last November also brought the election of a new Governor, Josh Shapiro, and a historic shift of power in the state House of Representatives with democrats edging out a one seat majority. These changes, coupled with the untimely death of Anthony DeLuca, a democratic member of the House, impacted the ability of the General Assembly to “hit the ground running” in early 2023. Adding to the political complexities of a new legislative session was the resignation of several democrat house members who had been elected to other offices, including Lt. Governor Austin Davis. As a result, the “business” of the House didn’t really get started in a serious way until April.
We were also happy to see the election of Arvind Venkat, MD, to the state House of Representatives, the first physician to do so since 1961. Since his swearing-in, Dr. Vankat has made a positive impression with members of his caucus and has, more than once, influenced or helped shape healthcare legislation in Harrisburg. We anticipate that Dr. Venkat will continue to be a driving force, and trusted source of clinical knowledge, to many members of the legislature. It should be noted that PAMED’s political action committee, PAMPAC, was an early supporter of Dr. Venkat’s candidacy.
Politics aside, we have seen a number of proposals put forth this legislative session that has PAMED very much engaged. We saw the reintroduction of Senate Bill 25, legislation that would grant CRNPs with independent practice authority and expect to see a companion bill introduced in the House before the end of the year. Legislation was also introduced to allow pharmacists to prescribe medications. A public hearing on this measure, House Bill 1000, was held in September with future stakeholder meetings expected. Staying with the theme of scope of practice expansion, PAMED has been engaged with the PA Chapter of the American College of Obstetricians Gynecologists in considering a legislative proposal that would no longer require nurse midwives to maintain a collaborative agreement with an OB/GYN. As of early December, consideration of these proposals is not expected in the near term.
While PAMED spends considerable resources on scope of practice issues, there are a number of bills, unrelated to scope, on which we are actively engaged. These include, but are not necessarily limited, to the following in no particular order:
Pennsylvania orders for Life Sustaining Treatment (POLST)—PAMED continues to work on moving proposals in both the Senate and House to address the issue of POLST. Sen. Gene Yaw (R-Lycoming) has introduced Senate Bill 631 and Rep. Tarik Kahn (D-Philadelphia) has introduced the companion bill in the House as House Bill 1212. Committee consideration of House Bill 1212 could come in early 2024.
Insurer credentialing—PAMED has identified Sen. Ryan Aument (R-Lancaster) as a possible sponsor in the Senate of legislation to shorten the time it takes to credential providers with health insurers. PAMED is working on several fronts to gather documented information on the delays in the credentialing process. It should be noted that Rep. Steve Mentzer (R-Lancaster) has introduced a version of our credentialing bill in the House as House Bill 1510.
Non-Compete Agreements—As mandated by the PAMED House of Delegates, we continue to discuss the issue of non-compete agreements in physician contracts with a number of legislators. Interest in this area seems to be growing as lawmakers learn more about how these contractual agreements negatively impact patient access and continuity of care. Sen. Michele Brooks (R-Venango) has re-introduced a proposal, Senate Bill 521, that would require a patient to be notified if their physician changes practices. Under the legislation, patients would receive the appropriate contact information for their physician should they choose to continue seeing their provider in another location. The bill would also void non-compete agreements when a physician is terminated “without cause.” The state hospital association, HAP, opposes this legislation.
In the House, Rep. Dan Frankel (D-Allegheny) has introduced House Bill 1633, a proposal that would outright ban the use of non-compete agreements in all physician employment contracts. PAMED will be working with Rep. Frankel, and other policy makers in the House, to move this proposal forward. While PAMED supports House Bill 1633, our support is contingent upon adding a provision that would permit the use of non-compete agreements by private physician practices.
Bio-markers—Legislation introduced by Sen. Devlin Robinson (R- Allegheny), Senate Bill 1754, would mandate that health insurers cover the costs associated with diagnostic tests to determine a given patient’s biomarkers related to a specific illness. Rep. Kyle Mullins (D-Lackawanna) has joined with Rep. Bryan Cutler (Lancaster) in introducing House Bill 954, another bio-marker proposal as well and a companion to the Senate version. PAMED, along with abroad coalition of provider organizations and patient advocacy groups, supports both legislative initiatives.
Telemedicine—PAMED is hopeful that a telemedicine bill may finally get to the Governor’s desk this legislative session. Sen. Elder Vogel (D-Beaver) has once again introduced Senate Bill 739 of which PAMED is supportive.
ED Overcrowding—PAMED has asked Governor Josh Shapiro to establish a task force on the issue of ED overcrowding. While no legislative remedy to this crisis has been introduced, PAMED hopes to work hand-in-hand with the Shapiro administration in identifying a solution and following through with its implementation.
Mental Health Access—PAMED, along with the Pennsylvania Psychiatric Society (PSA), has embraced the collaborative care model between psychiatrists and primary care physicians as a way of expanding mental healthcare services to patients in need. House Bill 849, authored by Rep. Mike Schlossberg (D-Lehigh) provides funding to establish coordinated care models in primary care offices. The language also includes a model that utilizes psychologists in care models as well.
Reproductive Health—PAMED has met with Rep. Leanne Krueger (D-Philadelphia) regarding her proposal to expand access to contraceptives. Her proposal, House Bill 1140, would remove limitations on the duration of prescriptions for patients taking medications that not only prevent pregnancies but also treat ailments such as endometriosis and Polycystic ovary syndrome. PAMED is working cooperatively with Rep. Krueger to "tighten” aspects of the bill to ensure that physicians ultimately have control of the prescription process.
Constitutional Amendment on Abortion—Rep. Danielle Friel Otten (D-Chester) introduced House Bill 1888, a constitutional amendment measure that would enshrine within the state constitution an individual’s right to exercise personal reproductive liberty related to pregnancy. The House Judiciary Committee held a public hearing to discuss the bill in mid-December and it is anticipated that the bill will be considered by the full House of Representatives in early 2024.
Although the current legislative session has been less than robust, a breast cancer related proposal authored by Sen. Kim Ward (R-Westmoreland) made it to the finish line in record time in May of this year. Senate Bill 8, lauded as a “first-of-its-kind” in the country to improve breast cancer screening coverage of necessary BRCA testing and screening for high-risk Pennsylvanians, had the support of PAMED and several patient advocacy groups. PAMED played an active role in helping to develop this legislation through several meetings between PAMED Board Chair and oncologist Ed Balaban, DO, and Sen. Ward’s legislative staff. The bill was signed into law by Governor Josh Shapiro as Act 1 of 2023.
As we near the end of the 2023 legislative calendar, PAMED is already looking ahead strategically on many of the issues contained in this report. We anticipate a busy legislative agenda in 2024 as lawmakers will be looking ahead to the state’s April primary election and of course, the Presidential election in November of 2024. As always, PAMED members are encouraged to develop relationships with their local state representatives and state senators. These relationships will play a key role in helping PAMED to achieve our legislative goals.