LEG REG REVIEW Health Edition
2019, 5th Issue *** February 25, 2019

LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol. It contains news on Pennsylvania legislation and regulations impacting the Insurance and Business Communities. Subscriptions are $100 per year and further information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/232-7005 or e-mail at xenobun@aol.com.

UPMC FILES MOTIONS AGAINST PA ATTORNEY GENERAL
Following up on Attorney General Josh Shapiro’s lawsuit early in February, UPMC filed its own lawsuit in Commonwealth Court February 21 against the Attorney General, asserting that Shapiro exceeded his legal authority by trying to dictate terms for UPMC and Highmark to do business together. According to news reports, (Pittsburgh Post-Gazette, KDKA-TV, AP etc.) part of the UPMC complaint is that federal anti-trust law was violated by the Attorney General’s lawsuit. NOTE: LEG-REG Review was unable to gain access to the actual text of UPMC complaint because the Commonwealth Court does not allow Internet access to court documents such as this unless the request comes from an attorney directly tied to the case. A fall-back would be to have the Commonwealth Court to charge a per-copy fee for a walk-in. (Source: Commonwealth Court 717-255-1650.) A call to UPMC was not returned by the time of writing this article and as of 5:30 p.m. February 25, there was no notice on their website.

DEPARTMENT CRITIQUES CMS ACA CHANGES
The PA Insurance Department submitted contents to the Centers for Medicare Medicaid Services (CMS) on proposed changes under the Affordable Care Act (ACA). Commissioner Jessica Altman expressed support for CMS’ continued support for coverage of Medication Assisted Treatment (MAT) for opioid users since it parallels the work PA is doing to remind issuers of the need to cover MAT for opioid users at the same level as MAT for non-opioid conditions. Also supported by the Department was the CMS plan for automatic renewal of Exchange plans if an individual did not take action during the open enrollment period. She did express concerns in a number of areas such as:

Changing a drug’s availability and cost-sharing in the middle of a policy year will cause confusion for people who rely on a specific formulary for drugs throughout the year.
Excluding a brand-name drug (even while covering the generic equivalent) will be considered by the PA Insurance Department as ‘an adverse benefit determination’ that warrants a right to appeal.
With regard to the CMS Notice of Benefit and Payment Parameters for 2020, Altman said that using premium growth across all private sector (non-Exchange) plans instead of the current use of premium growth from only employer plans would have “unintended consequences” such as reducing the amount of the ACA subsidy. This premium adjustment percentage is used to determine the amount paid by Exchange users, the cap on out-of-pocket costs, the amount of the Health Insurance Tax (Federal premium tax), and the fines to those businesses which are non-compliant with the Employer Mandate.

Commissioner Altman also said that CMS notices should be sent out in the fall to provide plan issuers with certainty and allow adequate time to prepare plan filings. The Georgetown University Health Policy Institute issued a summary of the CMS Notice of Benefit and Payment Parameters on January 24. http://chirblog.org/the-proposed-2020-notice-of-benefit-and-payment-parameters/
The comment period on the proposed Notice closed February 19.

COMING UP…

On February 28, the House Democratic Policy Committee will meet in Wilkes-Barre to receive testimony on “Affordable Health Care”.
On March 13, the PA House Health Committee will convene a hearing on Pharmacy Benefit Managers in Harrisburg.

BALANCE BILLING DISCUSSED AT HOUSE HEARING
The House Insurance Committee held two hearings to study the issue of balance billing also known as ‘surprise billing’. This practice stems from the fact that hospitals will utilize independent contractors for specialty work such as anesthesiology who are not in an insurer’s network. The patient receives this care believing that it would be covered because the hospital is in-network. The ‘surprise’ comes in that the non-network bill is considerably higher. Testimony was presented by Hospital & Healthsystem Association of PA (HAP), health care providers, and insurance companies. Insurance Committee Chair Rep. Tina Pickett (R-Bradford) and Senator Judy Schwank (D-Berks) will be introducing legislation addressing this issue.

ALTMAN CAUTIONS CONGRESS ON SHORT-TERM PLANS
PA Insurance Commissioner Jessica Altman testified before the U.S. House Energy & Commerce Committee about potential harms she sees coming from the Trump Administrations changes to short-term limited duration health insurance. She said that the plans are not an affordable alternative to comprehensive insurance because the limited plans have limited coverage. In her testimony, the Commissioner stated that “Consumers may experience an up-front savings in premiums but (their) affordability will likely prove to be illusory: those who need health care will run up against exclusions and limitations on coverage that, while making the purchase price more affordable, will do so only as a trade-off for benefit coverage and provider access.” She referenced complaints from insurance consumers because of the short-term policies’ fine print.

Altman also stated that short-term, limited duration plans neither cover pre-existing conditions nor provide essential health benefits like substance abuse disorder treatment as well as maternity care, prescriptions, mental health care, preventive (first-dollar) care and many other benefits found in comprehensive plans.

A link to Commissioner Altman’s testimony follows: https://www.insurance.pa.gov/Documents/Press%20and%20Communications/Testimonies%2c%20Remarks%2c%20Speeches/2019/Testimony-Altman-ACA%20Leg%20Hearing-021319.pdf

VENUE MEDICAL MALPRACTICE RULE PUT OFF
In response to pressure generated by the PA Coalition for Civil Justice Reform, health care providers, and legislators, notably with Senate passage of Senate Resolution 20 sponsored by Judiciary Committee Majority Chair Lisa Baker (R-Luzerne/Pike/Susquehanna/Wayne/Wyoming), the PA Supreme Court put a review of Rule 1006 (a.1.) also known as the Venue Rule, on hold. SR 20 directs the Legislative Budget & Finance Committee to research the medical malpractice market in PA after a 2003 requirement went into effect dictating that lawsuits must be tried in the county in which the alleged incident occurred. Also, on January 30, the House Republican Policy Committee held a hearing on the issue and received testimony from the Insurance Federation of PA, PA Medical Society and other health care provider groups.

Supporters of the current Venue Rule said that a Supreme Court’s Civil Procedural Rule Committee recommendation to rescind the Rule would set the clock back to a return to higher Medical Malpractice Insurance premiums and a corresponding reduction in the supply of doctors available to meet patient needs.

REGULATORY UPDATE
On February 16, the PA Insurance Department released the list of ten companies which have submitted Student Health Insurance Plans for review: Aetna; AmeriHealth; Commercial Casualty; Highmark; Keystone; National Guardian; QCC Insurance Company; Sirius America; UnitedHealthcare; and UPMC. Questions: Tracie Gray at tgray@pa.gov.

IN PASSING…Former Delaware County Senator Ted Ericksen passed away at age 80.