LCHM Summer 2018 - 29

L C M E D S O C .O R G

LEGISLATIVE
UPDATES

Pennsylvania Medical Society

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.

Recently, this issue has gained increased the duty to obtain a patient's informed consent
attention due to a CNN story outlining details is a non-delegable duty. Under the MCARE Act,
of an investigation into Aetna, where a former except for emergencies, physicians must obtain
medical director admitted under oath that he informed consent from their patients, or their
never looked at patients' records when deciding authorized representative, prior to conducting
to approve or deny care. The Scranton Times also the following procedures:
ran an editorial titled "Stop insurers from dragging
feet on care," which ran in all the Times-Shamrock * Performing surgeries (including the related
family of newspapers.
administration of anesthesia)
* Administering radiation or chemotherapy
Please note: The Pennsylvania Insurance
PAMED has used the media activity as a * Administering a blood transfusion
Department does not have jurisdiction over, and springboard, writing a letter to Acting Insurance * Inserting a surgical device or appliance
therefore cannot investigate, self-insured plans Commissioner Jessica Altman urging her to review * Administering an experimental medication
as a result of the Employee Retirement Income all licensed insurers and their prior authorization
Security Act of 1974 (ERISA). The Pennsylvania processes, and writing to the full House of
PAMED's legal and government relations
Insurance Department can investigate complaints Representatives urging their support of HB 1293. team has been working with the Hospital and
from most other insurance plans.
Healthsystem Association of Pennsylvania (HAP)
In March, Gov. Tom Wolf removed prior to draft legislation that aims to address physician
PAMED is hopeful that the House Insurance authorization requirements for opioid treatment concerns with this ruling. Stay up to date and
Committee, where HB 1293 currently awaits under Medicaid. PAMED applauds Governor get member-only resources at www.pamedsoc.
consideration, will take some action on the Wolf for recognizing negative consequences org/InformedConsent.
measure in the near future. Now more than ever, prior authorization can have on this population
it is imperative that all PAMED members push of patients.
TEAM-BASED CARE AND SCOPE OF PRACTICE
for this legislative change, which aims to increase
On April 26, 2017, passage of SB 25 occurred
transparency and standardization and improve INFORMED CONSENT
response times with prior authorization.
In a June 2017 ruling, the Pennsylvania SuContinued on page 30
preme Court held that, under the MCARE Act,
SUMMER 2018 | Lehigh County Health & Medicine 29


http://www.LCMEDSOC.ORG http://www.pamedsoc http://www.pamedsoc

Table of Contents for the Digital Edition of LCHM Summer 2018

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