Reauthorization of CHIP; Surprise Balance Bill Protection Act (HB 1553); Patient Test Result Information Act (HB 1884); Senate Bill 542, Provider Orders for Life-Sustaining Treatment (SB 623); Medical Service Agreement Act (SB 926); Pharmaceutical Pricing Transparency. Act (SB 637)
Written by Legislative Consultant, Bruce Hironimus

December 14, 2017

The State Senate and House concluded session for the remainder of 2017, but will continue the ongoing session into 2018. The final week brought a flurry of committee and floor action, with a number of POMA relevant issues in play.  

  • The General Assembly reauthorized CHIP.  While federal lawmakers have not yet paid for the program, the Pennsylvania General Assembly has now reauthorized the state’s Children’s Health Insurance Program (CHIP) for another two years.
  • The Surprise Balance Bill Protection Act (HB 1553) was adopted with an amendment and provides for the protection of consumers of health care coverage against surprise balance bills for emergency health care services or for other covered health care services when health care services are sought from in-network facilities. The bill states an out-of-network provider which renders a health care service to an insured may not surprise balance bill the insured for any amount in excess of the cost-sharing amounts that would have been imposed if the health care service had been rendered by an in-network provider. Upon request, the insurer shall furnish to the out-of-network provider a statement of the applicable in-network cost-sharing amounts owed by the insured to the provider. The insured shall be responsible for no more than the cost-sharing amounts that would have been due if the service had been rendered by an in-network provider. 
  • The Patient Test Result Information Act (HB 1884) provides for summaries or copies of patient test results to be sent directly to the patient or the patient’s designee when there is a finding of a significant abnormality. 
  • Senate Bill 542 amends the Pharmacy Act regarding the required notification by a pharmacist to the prescriber within 72 hours if an emergency prescription is dispensed, to clarify that if the prescription is not dispensed or sold in a 72-hour supply, then an amount not to exceed a 30-day supply or amount may be dispensed or sold.
  • Provider Orders for Life-Sustaining Treatment (SB 623) was advanced by the Senate Health and Human Services Committee which establishes a physician order which travels with the patient for end of life treatment.
  • The Senate Banking and Insurance Committee held a hearing regarding the Medical Service Agreement Act (SB 926) which provides for direct primary care, medical service agreements and insurance. A physician providing direct primary care based on a medical service agreement shall not be considered an insurer or health maintenance organization under Commonwealth law and the physician shall be not subject to regulation by the Insurance Department for direct primary care. a medical service agreement shall not be considered health or accident insurance or coverage and shall not be subject to regulation by the department. A physician shall not be required to obtain a certificate of authority to market, sell or offer a medical service agreement or provide direct primary care.  The House passed a companion bill (HB 1739) which awaits Senate consideration.
  • The Senate Banking and Insurance Committee passed the Pharmaceutical Pricing Transparency. Act (SB 637).  The bill as amended now places the responsibility with the Insurance Department for the collection and dissemination of the pharmaceutical information.  The previous language with stakeholder representative on a commission was removed from the bill.
  • The State Department Bureau of Professional Licensing, under the direction of the Governor’s recent executive order, will commence a comprehensive review of existing boards and regulations.  A kick-off meeting will be held on January 9, 2018.  Preliminary discussions with key Legislative Committee Chairs have centered on preserving the Osteopathic Medical Board. 

The General Assembly formally returns on January 2, 2018 but voting session begins again on January 23, 2018.