Pennsylvania Legislation

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.

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

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

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

Creative clinical laboratory arrangements seem to be proliferating of late in Pennsylvania. Laboratories, like many providers, are eager to find ways to more closely align with referring physicians. Such arrangements can take a variety of forms such as shared space and personnel arrangements as well as various kinds of marketing arrangements.

Providers considering such arrangements

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

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/

 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 fact, only this week I saw a documentary spotlighting the newest illegal drug epidemic sweeping the northeast: prescription pain pills purchased from doctors in Florida and trafficked up the route 95 corridor for sale on the street.  With a street value of up to $80 per pill, prescription meds may be more profitable and easier to obtain than cocaine.

As an indication that a regulatory correction is just around the corner, a recent New York Times article casts a spotlight on the huge mark-up on prescription drugs that physicians are able get under state workers compensation programs and efforts by state legislators to control the associated costs. (See Insurers Pay Big Markups at http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?_r=2&pagewanted=all).


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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

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.