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Category Archives: Pennsylvania Legislation

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Pennsylvania Senate Bill would Limit Retroactive Denials

Posted in Pennsylvania Legislation, Reimbursement

These days, more often than not, physicians and up on the short end of the stick when it comes to new health care legislation. However, last month a bill was introduced by Senator David Argall which, if passed, would give physicians and other healthcare providers important protection against retroactive insurance denials. Specifically, Senate Bill No.… Continue Reading

Bill Limits Physician Dispensing Under Pennsylvania Workers’ Compensation Program

Posted in Pennsylvania Legislation

Physicians in Pennsylvania who have been dispensing and billing for prescription drugs under the Pennsylvania Workers’ Compensation program will be disappointed to learn that House Bill 1846 (which already passed the House) was approved by the Pennsylvania Senate yesterday, essentially clearing the way for the bill to be signed into law.  HB 1846, among other… Continue Reading

Pennsylvania gets Federal Approval for Medicaid Expansion

Posted in Pennsylvania Legislation

The Centers for Medicare and Medicaid Services (CMS) has agreed to permit Pennsylvania to expand its Medicaid program under the federal Affordable Care Act to cover low income adults whose incomes exceed the federal poverty level.  Pennsylvania will join 26 other states in expanding its Medicaid program under the statute.  With the expansion, the Pennsylvania Medical… Continue Reading

Pennsylvania Department of Health Clarifies Clinical Laboratory Law

Posted in Ancillary Services, Pennsylvania Legislation

On December 18, 2013, Pennsylvania Act 122 amended the Pennsylvania Clinical Laboratory Act to, among other things, impose licensure requirements on out of state clinical laboratories and to place certain prohibitions on physician financial arrangements with labs.  Among other things, Act 122 prohibits the payment or receipt of commissions, bonuses, kickbacks or fee-splitting arrangements and prohibits laboratories from… Continue Reading

2013 Pennsylvania MCARE Insurance Assessment Announced

Posted in Pennsylvania Legislation

The Pennsylvania Insurance Department has announced that the Medical Care Availability and Reduction of Error (MCARE) Act annual assessment for calendar year 2013 will be 25% applied to the prevailing primary premium for each participating health care provider.  The announcement is in  the Pennsylvania Bulletin.  This represents an increase of two percentage points from the 2012 assessment.… Continue Reading

J-1 Physician Waivers in Pennsylvania: Change in Processing Times

Posted in Pennsylvania Legislation

On October 9, the Pennsylvania Department of Health (PA DOH) announced that it has changed the Pennsylvania rules regarding the J-1 Physician Waiver Program. DOH has established three filing periods, which could result in the Conrad 30 numbers being assigned earlier in the fiscal year. Read the entire text: http://immigrationview.foxrothschild.com/j-1-waiver/j-1-physician-waivers-in-pennsylvania-change-in-processing-times/  

Posted in Pennsylvania Legislation

 I mentioned recently to one of my physician practice clients that all indications suggest to me that in-office dispensing of drugs by physicians is likely to become a target for increased regulation and enforcement.  It seems like at least once a week we hear in the news about another tragedy involving prescription drug addiction.  In… Continue Reading

Pennsylvania Board of Medicine Proposes Rewrite of Prescribing Regulations

Posted in Pennsylvania Legislation

Last week, the Pennsylvania Board of Medicine published proposed regulations amending the physician controlled substances prescribing regulations to, among other things, expand the regs to include butalbital, carisoprodol and tramadol hydrochloride.  Under the proposed regulations, these drugs would now be subject to the same requirements applicable in Pennsylvania to physician office prescribing of controlled substances, including… Continue Reading

Physicians: Be Aware of the Pennsylvania Sales and Use Tax

Posted in Pennsylvania Legislation

Most medical practices in Pennsylvania are aware that Pennsylvania imposes a sales and use tax on various items and services purchased by medical practices.  However, physicians are not always clear on exactly the items and services to which the tax applies.  For example, the tax applies to secretarial/administrative services purchased from a third party vendor. … Continue Reading

Pennsylvania Adopts Physician Identification Badge Law

Posted in Pennsylvania Legislation

Physicians in Pennsylvania should be aware that a new Pennsylvania law requires physicians and their employees who provide direct patient care to wear a photo identification badge during work hours. The law became effective on January 22, 2011 and the Department of Health is required to publish regulations clarifying the law within 90 days. The law… Continue Reading

West Penn Allegheny Antitrust Suit Dismissed

Posted in Pennsylvania Legislation

According to a recent article in the Pittsburgh Post-Gazette, West Penn Allegheny Health System’s federal antitrust lawsuit against University of Pittsburgh Medical Center and Highmark Inc., has been dismissed.  Filed in April of this year, the lawsuit alleged that UPMC and Highmark conspired to raise prices and squeeze out competition.  According to the article, the… Continue Reading

Insurance Department to Investigate the Blues in Pennsylvania

Posted in Pennsylvania Legislation

In what many Pennsylvania physicians feel is a long overdue move, the Pennsylvania Insurance Commissioner has announced that the Department of Insurance will investigate whether any of Pennsylvania’s Blue Cross-Blue Shield insurers have engaged in anti-competitive behavior in violation of the Unfair Trade Practices act.  According to a recent article in the Pittsburgh Post-Gazette, among other… Continue Reading

Proposed Pennsylvania Legislation Would Prohibit Physician Referrals for Ancillary Services

Posted in Fraud and Abuse, Pennsylvania Legislation

Pennsylvania physicians need to be aware that legislation (House Bill 1405) has once again been introduced in the Pennsylvania House which would severely limit the ability of physicians to refer to entities in which they have investment interests. As drafted, this Bill would create an outright prohibition on the referral by a health care provider… Continue Reading

West Penn Allegheny Health System Inc. Files Anti-trust Lawsuit Against University of Pittsburgh Medical Center and Highmark Inc.

Posted in Pennsylvania Legislation

Things appear to be heating up between the lagest health system and the second largest health system in the Pittsburgh health care market.  West Penn Allegheny Health System Inc. has filed and anti-trust lawsuit against the University of Pittsburgh Medical Center and Highmark Inc., the region’s largest insurer, claiming UPMC and Highmark have conspired to… Continue Reading

Pennsylvania Gives Nurse Midwives Authority to Prescribe

Posted in Pennsylvania Legislation

The Pennsylvania Board of Nursing has published regulations implementing a 2007 law which gives nurse midwives the authority to prescribe, administer, and dispense drugs pursuant to collaborative agreement with a physician. The law and regulations also apply to medical devices, immunizing agents, and laboratory tests.  In order to obtain prescriptive authority, nurse midwives must hold… Continue Reading

IBC and Highmark Call Off Merger

Posted in Pennsylvania Legislation

In what is surely to be a bright spot for most physician in Pennsylvania, Independence Blue Cross and Highmark announced today that they are withdrawing their request to merge.  According to a report by the Philadelphia Inquirer this afternoon, the boards of two companies met today and decided they could not live with the condition… Continue Reading

Highmark Blue Shield and Independence Blue Cross Merger in the News

Posted in Pennsylvania Legislation

According to an article in today’s Philadelphia Inquirer, the Pennsylvania Insurance Department has apparently unofficially informed Highmark Blue Shield and Independence Blue Cross of certain conditions it will place on the merger.  One condition, according to the Inquirer, would be that the combined company use only the Blue Shield trademark, but cease using the Blue Cross trademark… Continue Reading

Highmark/IBC Merger Ruling Delayed

Posted in Pennsylvania Legislation

According to a recent article in the Philadelphia Business Journal, the Pennsylvania Insurance Department will not issue a ruling on the merger until early next year.  This is because the Insurance Department must wait 105 days from the end of the public comment period.  Due to certain omissions from the public notice published last month,… Continue Reading

MCARE Abatement Program Still A Political Football

Posted in Malpractice Insurance, Pennsylvania Legislation

According to a recent article in the Patriot News, Governor Rendell has outlined the costs associated with his plan to provide health insurance for Pennsylvania’s uninsured population.  The plan calls for increases in taxes on tobacco products and would tap into the MCARE fund to cover the health insurance costs.  However, according to Rendell, the plan would result in enough money to… Continue Reading

Medical Society Predicts Doctor Shortage in Pennsylvania

Posted in Pennsylvania Legislation, Practice Management

More not-so-good news for Pennsylvania: according to an article in the Times Tribune, Pennsylvania Medical Society officials are predicting a shortage of physicians in Pennsylvania in the foreseeable future.  Citing the Society’s recently released demographic report (See The State of Medicine in Pennsylvania), the article suggests that Pennsylvania could be short 10,000 doctors within 10 years.  Pennsylvania’s… Continue Reading

Pennsylvania Governor Softens Position on MCare Subsidies

Posted in Malpractice Insurance, Pennsylvania Legislation

Much to the chagrin of practicing Pennsylvania physicians, the issue of MCare premium subsidies became a political football earlier this month when Governor Ed Rendell said he would not approve the 2008 MCare subsidy until Pennsylvania lawmakers acted on his proposal to expand the state insurance program to uninsured adults.  The proposal calls for using a… Continue Reading