ChesterCountyMedicine Spring 2018 - 34

www.CHESTERCMS.org

QUARTERLY
LEGISLATIVE UPDATE
Prior Authorization Reform
The Pennsylvania Medical Society (PAMED) is advocating
for reforms to the prior authorization process. We continue to
urge affected physicians and their patients to file complaints
with the Pennsylvania Insurance Department, contact their State
Representative in support of HB 1293, and share patient stories at
www.pamedsoc.org/PriorAuth.
Please note: The Pennsylvania Insurance Department does not
have jurisdiction over, and therefore cannot investigate, self-insured
plans as a result of the Employee Retirement Income Security Act
of 1974 (ERISA). The Pennsylvania Insurance Department can
investigate complaints from most other insurance plans.
PAMED is hopeful that the House Insurance Committee,
where HB 1293 currently awaits consideration, will take some
action on the measure in the near future. Now more than ever, it
is imperative that all PAMED members push for this legislative
change, which aims to increase transparency and standardization
and improve response times with prior authorization.
Recently, this issue has gained increased attention due to a
CNN story outlining details of an investigation into Aetna, where
a former medical director admitted under oath that he never
looked at patients' records when deciding to approve or deny care.
The Scranton Times also ran an editorial titled, "Stop insurers from
dragging feet on care," which ran in all the Times-Shamrock family
of newspapers.

34 CHESTER COUNT Y Medicine | SPRING 2018

PAMED has used the media activity as a springboard, writing
a letter to Acting Insurance Commissioner Jessica Altman urging
her to review all licensed insurers and their prior authorization
processes, and writing to the full House of Representatives urging
their support of HB 1293.
In March, Gov. Tom Wolf removed prior authorization
requirements for opioid treatment under Medicaid. PAMED
applauds Governor Wolf for recognizing negative consequences
prior authorization can have on this population of patients.

Informed Consent
In a June 2017 ruling, the Pennsylvania Supreme Court
held that, under the MCARE Act, the duty to obtain a patient's
informed consent is a non-delegable duty. Under the MCARE Act,
except for emergencies, physicians must obtain informed consent
from their patients, or their authorized representative, prior to
conducting the following procedures:
* Performing surgeries (including the related administration of
anesthesia)
* Administering radiation or chemotherapy
* Administering a blood transfusion
* Inserting a surgical device or appliance
* Administering an experimental medication


http://chestercms.org/index.html http://www.pamedsoc.org/PriorAuth

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