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physicians of the many frustrating hurdles
that health insurers require physicians to
navigate. As one could expect, health insurers
are pushing back hard...even before the
legislation is formally introduced. This issue
has also attracted the interest of freshman
State Senator Kristin Phillips-Hill of York
County who recently announced her interest
in introducing a similar bill in the Senate. It is
quickly becoming clear to both lawmakers and
patients that prior authorization needs reformed
as more and more patients are facing denials
for services recommended by their physician.
Positive change will largely be driven by patient
and physician engagement on this issue since
overcoming the political influence of the state's
health insurance industry will be challenging.
Opioid awareness is ubiquitous throughout
the physician community and remains a top
priority in the legislature. As we approach the
end of the year, three opioid bills have the
potential of moving-Senate Bills 566, 572,
and 675. The first would take existing opioid
prescribing guidelines developed by PAMED,
in cooperation with the Department of Health,
and codify them in regulations. While the
intention of the legislation is to ensure that
physicians adhere to the guidelines, PAMED
feels strongly that guidelines should not be
mandated and must, by their very nature, be
flexible given the uniqueness of each and every
patient. In addition, treatment protocols change
often and placing guidelines into the regulatory
process would likely result in physicians being
caught between new treatment protocols and
outdated regulations - potentially denying
patients the most up-to-date care.
Senate Bill 572 would require patients to
submit to a drug test and to have the patient
sign an opioid treatment agreement prior to
receiving an initial opioid prescription. Interestingly, while the bill mandates the screening,
it does not require health insurers to pay for
it.. Without mandatory insurance coverage for

the screening, patients who cannot afford the "waiting in the wings." These include, but are
tests would be unable to receive appropriate by no means limited to, the following:
treatment for their chronic pain. PAMED
Out of Network Billing, -House Bill 1862,
understands and recognizes that more needs to has been formally introduced. PAMED and
be done to help those with opioid use disorder the broad coalition of providers oppose the
such as alternatives therapies, non-opioid bill as written. Efforts are underway to seek
medications, and early and effective substance amendments to the legislation that will level
use disorder treatment.
the playing field between providers and insurers
while at the same time remove patients from
Lastly, Senate Bill 675, seeks to restrict the the middle.
use of medically assisted treatment (MAT) for
patients suffering from opioid use disorder.
The Kaufer amendment (#A3599) - SupDrugs like buprenorphine have been proven ported by the provider community, this
to be the most effective treatment for patients amendment will remove the median in-network
who suffer from addiction. Currently, the rate as the state mandated payment standard
bill also requires patients to seek behavioral and put in its place "all reasonably necessary
therapy to qualify for buprenorphine treatment. costs," which is the existing payment standard
While it is considered best practices to receive for emergency services in our state and has
counselling in addition to MAT, PAMED been for the past 20 plus years.
opposes the language mandating therapy.
PAMED is part of a broad-based coalition,
The Rothman amendment (#A3601) - As
strongly oppose this legislation.
currently drafted, this bill only permits arbitration to look at the accuracy of a payment
For several legislative sessions, PAMED has determined by an insurer, with no checks and
been seeking a legislative remedy that would balances in place. This amendment calls for
speed up the health insurance credentialing independent dispute resolution (IDR) to look
process for physicians. PAMED is pleased at whether the payment is appropriate. Further,
that House Bill 53, legislation to address this it encourages fair physician claims and insurer
issue, is beginning to get some traction in the payments from the beginning, as both sides
General Assembly. Newly licensed physicians, rise additional expense if take to IDR through
or physicians moving into a different insur- the American Arbitration Association (AAA).
ance market, often experience lengthy delays
PAMED is seeking to amend or repeal
in getting credentialed by insurers. During Act 112 that was approved last year. The Act
that process these individuals are unable to requires physicians who interpret imagining
treat patients often denying patients access studies that show a "significant abnormality"
to care. House Bill 533 seeks to limit the must notify patients that the studies have been
amount of time insurers can take to approve, read and that follow-up with the referring
or deny, credential applications to 45-days physician is recommended.
and standardizes the process by requiring the
use CAQH application forms. Several orgaFor more information about any of the
nizations, including the Hospital Association, items mentioned above, please visit the
have joined with PAMED to see this measure Advocacy Section of PAMED's web site at
cross the finish line.
There are several other important issues
either pending before the state legislature or

PAMED continues to address additional advocacy issues affecting Pa
physicians and patients, such as telemedicine, informed consent,
and proposed venue rule changes . For more information, visit

Central PA Medicine Fall 2019 29

http://www.dauphincms.org http://www.pamedsoc.org http://www.pamedsoc.org/Advocacy

CPM Fall 2019

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