Government Relations
PDA Scores a Legislative Victory at 2016 Session Conclusion
PDA took the lead in a health care provider coalition lobbying for HB 2241, legislation limiting the timeframe in which insurers may retroactively review and deny claims to 24 months, with some exceptions. Current law allows insurers an indefinite amount of time to demand providers repay previously paid claims. We are happy to report that the General Assembly passed HB 2241 on its last day of session in 2016. Governor Wolf signed HB 2241, now Act 146, into law on November 4. The law became effective on January 3.
Act 146:
• Restricts the amount of time an insurer has to retroactively deny reimbursement to a health care provider to 24 months.
• Requires retroactive denial of reimbursements to be based upon coding guidelines and policies that were in place at the time the services in question were provided.
• Requires insurers to give health care providers written notice about the reasons for the retroactive denial.
• Gives health care providers 12 months to submit a claim for retroactive denials based on coordination of benefits.
• Specifies that a health care provider has 60 days to respond to an insurer request for medical or billing records related to a denial.
• Provides that the act does not apply to cases of waste, fraud, abuse, duplicate claims, denials resulting from a state or federal government plan, or when services were subject to coordination of benefits with another insurer.
Passing this meaningful insurance reform wasn’ t easy. It took many years in which PDA provided testimony and data to the legislature, participated in stakeholder meetings with other health care provider groups, insurers and legislators, and cultivated support from leaders in the House and Senate to move the bill. Our collective work paid off due to efforts made by staff, lobbyists and volunteer members. Many thanks to those of you who responded to PDA’ s action alerts requesting that you contact your Representative and Senator. Passage of HB 2241 illustrates how advocacy through organized dentistry pays off— helping you maintain a viable dental practice!
General Assembly Passes Package of Bills Addressing Opioid Epidemic
Education The General Assembly passed SB 1368, now Act 126, which requires all health care licensing boards to develop curriculum related to safe prescriptive practices of controlled substances. The curriculum must include current, age-appropriate information on pain management, alternatives to opioid pain medications, instructions on safe prescribing methods, identification of patients at risk for addiction, and training on managing substance use disorders when treating patients with chronic conditions. Schools will have the option of mandating students complete the course as condition for graduation. Act 126 requires licensing boards to develop the curriculum by August 2017.
Patient Non-Opioid Directive Form Act 126 also requires the Secretary of Health to develop and publish a uniform voluntary non-opioid directive that patients may use to deny his or her health care provider from supplying, prescribing or otherwise administering a controlled substance containing an opioid. The Department of Health must post the directive on its website for download.
Patients will have the right to file a voluntary non-opioid directive form with a provider, and must sign and date the form in front of the provider or his / her designee. The provider must sign the form in the patient’ s presence and return a copy of the signed form to the patient. Patients unable to execute the form may designate a guardian or health care proxy to file the form. Patients may revoke the directive form for any reason either verbally or in writing. Providers may also override a previously filed voluntary non-opioid directive form based on documented medical judgment and record this decision in the patient’ s chart.
If a provider assesses a patient’ s personal and family history and determines he or she is at risk for a substance use disorder, the provider should query the Prescription Drug Monitoring Program( PDMP) database, sign the directive and note the query and signed form in the patient’ s record.
In cases where patients have signed voluntary non-opioid directive forms, practitioners and their employees acting in good faith will not be subject to criminal or civil liability.
JANUARY / FEBRUARY 2017 | PENNSYLVANIA DENTAL JOURNAL 7