State Legislative Updates

Things to know about the New Prior Authorization Law in Pennsylvania! (SB 225/ACT 146)
 

• Expands reforms to prior authorizations to all insurers including Medicaid and CHIP plans.

• Clearly defines “closely related services” which now do not require prior authorization. Closely related services include any service a “prudent health care provider reasonably expected to perform in conjunction with or in lieu of an originally authorized service in response to minor differences in patient characteristics or needs for diagnostic information not readily identifiable before performing the authorized service.”

• The time Frames for decisions changed from time of ‘complete request’ and is now from the time of submitting a request:

• Urgent health care services: as soon as possible, but no more than 72 hours. If request is made 24 hours prior to reduction or termination of existing treatment, within 24 hours.

• Non-urgent medical services: not more than 15 days from submission.

• Prescription drugs –

• Urgent requests not more than 24 hours.

• Standard requests, two business days not to exceed 72 hours in total.

• If at any time after requesting prior authorization, the health care provider determines the enrollee's medical condition requires emergency services, then the emergency services may be provided without prior authorization.

•  Adds specialty specificity! The law requires prior authorization may only be denied after review by or consultation with a licensed medical professional in the same or similar specialty. Physicians submitting the prior authorization request can delegate a proxy who is a licensed professional, such as another physician, resident, physician’s assistant, or nurse practitioner, to complete the peer-to-peer review.

• Upon submission and review by an insurer, if a request prior authorization is missing clinical information necessary to complete a review, the insurer must notify the provider that information is missing as soon as reviewed, and the insurer must provide enough specificity to the submitting provider to enable identification of the necessary information required to complete review. The insurer may extend the provider up to 45 additional days beyond the time limits if necessary to obtain the missing information.

• Significantly expands the definition of what constitutes “medical or scientific evidence” and clinical standards to support approvals.

 
In addition, the law addresses adequacy of networks and timely payment:
 

• Assures treating health care network sufficiency through the requirement that insurers, MCOs and contractors assure availability and accessibility of adequate health care providers in a timely manner.

• Creates a requirement that insurers adopt procedures for an enrollee with a life-threatening, degenerative, or disabling disease or condition can receive a standing referral to a specialist.

• Requires that all insurers and MA/CHIP managed care plans pay all clean claims within 45 days of receipt of the claim.

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Pennsylvania's Indoor Tanning Regulation

PA Senator Pat Browne with eight cosponsors recently introduced PA Senate Bill 909 which would prohibit the use of indoor tanning facilities for those under the age of 18. This will replace the legislation from May 6, 2014,  Act 41 of 2014 which prohibits use of tanning facilities by minors under the age of 17, and requires parental consent for 17-year-olds.

It also requires:
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• tanning facilities to post warning signs on the premises , and keep records for three years;

• customers to sign a written warning statement prior to tanning;

• tanning devices meet federal and state standards;

• and employees of tanning facilities to have training in both the use of the devices and recognition of customer skin types.

According to the Skin Cancer Foundation, every year nearly 2.3 million American teenagers visit tanning salons. In addition, a study published in the International Journal of Cancer in May 2011 determined that for young people diagnosed with melanoma between the ages of 18 and 29 years old, 76 percent were attributable to indoor tanning bed use. Access to Sun Protection in Schools- HB 1228
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On October 17, 2018, House Bill 1228, which aims to increase access to sun protection in schools, received final passage in the Senate with a vote of 49-0. The bill was signed into law by the governor on October 24, 2018.  

This legislation ensures the following: 

1. Allows students to possess and apply their own approved non-aerosolized sunscreen

2. Eliminates burdensome requirement of a doctor’s note and a visit to the school nurse to apply an FDA approved sunscreen.

3. Allows for the outdoor use by students of sun-protective clothing, including, but not limited to hats.​

 

The PAD would like to thank Representative Hal English for sponsoring this legislation. 

Organizations that Support Indoor Tanning Legislation