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