G ove r n men t Re lat ions
The question that loomed for months on Pennsylvania’s political
scene was whether or not the General Assembly and Wolf
Administration could agree on a budget for fiscal year 2017-18
by the June 30 deadline. To no great surprise, the answer turned
out to be “no.” At the time of publication, the legislature and
Governor were still churning out a state budget.
Legislators will soon be home until mid-September, which
is a perfect time to meet with your senator and representative!
Meet with them during PDA’s Legislative Check-Up Week,
scheduled for September 11-15. Make an appointment with
your lawmakers and we’ll send you all of the background
information and talking points you’ll need to discuss the
legislation that will impact your profession and patients. Find
out more by logging on to PDA’s website at www.padental.org
and clicking on Legislative Check-Up Week under the Advocacy
tab. Or contact the government relations department at (800)
223-0016 or mss@padental.org.
Assignment of Benefits
At PDA’s request, Sen. John Eichelberger (R-Blair) and Rep. Stan
Saylor (R-York) reintroduced assignment of benefits legislation
in the Senate and House. SB 373 and HB 823 would require
insurers to honor patients’ request to assign benefits directly to
dentists, regardless of whether or not their dentist participates
with the insurer. Payment from the insurer to the dentist may
not exceed the amount that the insurer would otherwise have
paid without the assignment of payment. Without assignment
of benefits, patients are forced to pay for the full amount of the
dental service upfront – which can be quite cost-prohibitive
– or dentists risk performing a service without guarantee of
payment. Assignment of benefits remedies this situation for all
parties and thus improves access to care.
PDA is aggressively lobbying for enactment of assignment of
benefits legislation, having spent much of 2016 and the
beginning of 2017 working with Senate and House leaders and
staff on language that satisfied their concerns about having
adequate consumer protection safeguards in place when it
comes to the issue of non-participating dentists accepting
the assigned benefit and balance billing patients. Stay tuned
for more information in upcoming editions of the Pennsylvania
Dental Journal.
SB 373 has 19 cosponsors and is assigned to the Senate Banking
and Insurance Committee. HB 823 has 42 cosponsors and is
assigned to the House Insurance Committee.
Insurer Credentialing
Rep. Matt Baker (R-Bradford, Tioga, Potter) introduced HB 125,
which would require health care providers, including dentists,
to use the Council for Affordable Quality Healthcare
credentialing application and for insurers to provide provisional
credentialing to eligible applicants if they fail to credential
within 30 days of having received the completed form.
Supporters for this legislation (including the PA Medical Society,
the Hospital and Health System Association of PA, the Coalition
of Nurse Practitioners, the PA Academy of Family Physicians and
the PA Association of Community Health Centers) contend that
physician practices, health centers and other providers regularly
face the situation where a newly-hired practitioner cannot be
reimbursed by insurers for months because of a cumbersome
credentialing process, which often results in the practitioners’
inability to work until they are properly credentialed.
HB 125 has 14 cosponsors and was assigned to the House
Health Committee, which voted in support in April. The House
of Representatives followed suit with a unanimous vote of
support in May. HB 125 is now assigned to the Senate Banking
and Insurance Committee.
Balance Billing
Reps. Tina Pickett and Matt Baker introduced HB 1553, legislation
aimed at protecting patients from surprise balance bills from
medical providers. Surprise balance billing happens when a
patient receives medical care from providers and at facilities
they believe are in their health insurance plan’s network, but
unknowingly receives services from an out-of-network provider.
Surprise balance billing can also occur following an emergency,
when a consumer has little or no control over where they are
taken to receive care, and are often taken to an out-of-network
emergency room.
The Surprise Balance Bill Protection Act would:
• Ensure that consumers are only responsible for their
in-network cost-sharing obligations.
• Instruct providers to bill insurers directly, while also allowing
consumers to trigger protections if they do receive a balance
bill.
• Instruct insurers to negotiate with providers to determine fair
payment for the services that consumers receive.
• Establish an independent arbitration process to determine
fair payment if the insurer and provider are unable to come to
an agreement on the reimbursement.
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