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Government Relations Update – October 15, 2013

Pennsylvania Issues


S.B. 358: Breast Density Screening Notification. On June 18, 2013, the Pennsylvania Senate unanimously passed a bill introduced by Senator Bob Mensch (R- Bucks, Lehigh, Montgomery, Northampton) which would require facilities offering mammograms to provide patients with information regarding breast density. According to Senator Mensch, dense breast tissue can hide abnormalities and complicate early detection of breast cancer, so women who have dense breast tissue should be aware of the associated risks. The Pennsylvania Breast Cancer Coalition (PBCC) and the Hospital & Healthsystem Association of Pennsylvania (HAP) support the bill. The American College of Obstetricians and Gynecologists opposes the bill, explaining that the notification would lead to additional, unnecessary imaging. The Pennsylvania Medical Society (PMS) also opposes the bill, asserting that the legislature should not determine treatment protocols, especially since they change rapidly. The bill has been sent to the House Health Committee for consideration.

H.B. 1656: Repeal of Consent for Treatment of Breast Disease (Act 213 of 1984). As previously reported, the Pennsylvania Consent for Treatment of Breast Disease Act of 1984 requires a separate consent form for the treatment of breast disease. On August 26, 2013, Representative Becky Corbin (R-Chester) introduced legislation to repeal the law. According to Representative Corbin, the law has become irrelevant, since it fails to address new and less invasive breast disease treatments. The House Health Committee unanimously approved the bill on October 2, 2013, and the bill will be forwarded to the House for consideration. Representatives Hahn (R-Northampton), Day (R-Berks, Lehigh), Simmons (R-Lehigh, Northampton) and Schlossberg (D-Lehigh) serve as members of the House Health Committee. HAP and the PBCC support the bill.


Tobacco Settlement Funds: Under the 1998 settlement with four of the largest tobacco manufacturers, 46 states and the District of Columbia will receive an estimated $206 billion over 25 years. States receive their portion of the payment based on tobacco sales. Pennsylvania receives about $300 million annually and uses the funds exclusively for health care, including support for medical assistance programs, reimbursement to hospitals for uncompensated care costs and funding for cancer research and tobacco cessation programs.

Fifteen states, including Pennsylvania, became involved recently in a settlement payment dispute with the tobacco companies. More specifically, the tobacco companies argued that Pennsylvania failed to properly enforce settlement provisions involving the taxation of nonparticipating manufacturers. On September 11, 2013, an arbitration panel ruled that Pennsylvania's payments for 2014 will be reduced from $300 million to $120 million. As a result of this decision, the Corbett administration announced that it will eliminate during the current fiscal year funding for hospital uncompensated care and health research programs and discretionary funding for tobacco prevention and cessation programs. HAP is carefully analyzing the impact of this decision and will prepare hospital-specific impact data for member hospitals.

Drug Overdose Deaths: According to a national study conducted by the Trust for America's Health, Pennsylvania has the 14th highest rate of drug overdose deaths in the country. The report, which was released on October 7, 2013, states that Pennsylvania had 15.3 overdose deaths per 100,000 residents in 2010, mostly involving prescription drugs. This represents an increase of 89% from 1989, when Pennsylvania experienced 8.1 drug deaths per 100,000 people. The report further notes that Pennsylvania is among 28 states, together with the District of Columbia, that have implemented six or fewer of 10 recommended strategies for controlling prescription-drug abuse. Pennsylvania satisfied only four of the strategies, including a law barring patients from withholding information from doctors about prior prescriptions and a law requiring doctors to examine patients or have a bona fide patient-physician relationship before prescribing a controlled substance. Pennsylvania has failed to implement six recommended strategies, including a law to expand the use of “naloxone,” a prescription drug that can help counteract an overdose, and a law requiring pharmacists to require patient identification before dispensing controlled substances.

Pennsylvania lawmakers are currently debating a bill that would create a statewide prescription drug monitoring program. The PMS favors the monitoring program, since it would help physicians and pharmacists track prescriptions and identify drug seeking patients who are “doctor shopping.” The American Civil Liberties Union of Pennsylvania opposes the bill amid concerns regarding potential threats to patient privacy.


Trauma Systems Foundation: State Representative Michael Schlossberg (D-Lehigh) has been appointed to serve as the Democratic Health Committee representative of the Pennsylvania Trauma Systems Foundation (PTSF). The PTSF is the accrediting body for trauma programs throughout the Commonwealth. The PTSF was created in 1984 by the combined efforts of the PMS and HAP, along with the Pennsylvania State Nurses Association, the Pennsylvania Emergency Health Services Council and the Pennsylvania Department of Health. Dr. William Hoff, Medical Director for Trauma Services at St. Luke's University Health Network, also serves on the PTSF board. Dr. Hoff had an opportunity to meet with Representative Schlossberg during the most recent PTSF meeting earlier this month. The PTSF recently granted Level IV Trauma Center Accreditation status to St. Luke's Hospital – Miners Campus.

Federal Issues


Government Shutdown and Federal Debt Limit Concerns: The United States constitution requires Congress to pass a spending plan by September 30th of each year in order to keep the federal government operational for the federal fiscal year commencing on October 1st. As part of the spending bill for the federal fiscal year commencing on October 1, 2013, House Republicans demanded the elimination of all funding for the Patient Protection and Affordable Care Act (PPACA). Senate Democrats refused to pass a spending bill without maintaining the funding for PPACA. As a result, Congress was unable to agree on a federal spending plan by the deadline, and, on October 1, 2013, the federal government shut down operations for first time in 17 years.

In an attempt to reach a resolution to end the impasse, Congressman Charlie Dent (R-15-PA), together with other moderate House Republicans, proposed a spending plan that would fund PPACA but repeal its 2.3% medical device tax. The medical device tax commenced on January 1, 2013 and is estimated to cost medical device manufacturers about $194 million each month. The tax is expected to cost Pennsylvania's economy about $100 million per year and adversely impact B. Braun Medical, Olympus and OraSure. House Speaker John Boehner (R-8-OH) has not responded to the Congressman's proposal or called for a vote to end the government shutdown.

Concomitantly, unless Congress acts to raise the federal borrowing limit by October 17, 2013, the Treasury Department warns that the United States will default on its loans. Speaker Boehner had proposed a six-week increase to the national debt ceiling in exchange for a commitment from the President and Democratic leaders to begin substantive bipartisan budget negotiations and efforts to reduce the federal deficit. However, the President refuses to begin any negotiations with the House Republicans until the government shutdown ends.

Hospital Observation Status: As previously reported, the final 2014 federal fiscal year Medicare inpatient prospective payment system (IPPS) rule established new criteria for determining the appropriateness of inpatient admissions. In general, the Centers for Medicare & Medicaid Services (CMS) will presume that surgical procedures, diagnostic tests and other treatments are appropriate for Medicare Part A inpatient hospital payment when the physician admits a patient based on the expectation that the patient will require a stay of at least two midnights. On September 5, 2013, CMS released guidance on admission order and certification requirements in connection with the new “two-midnight” benchmark. The guidance addresses standards for physician certification of hospital services, such as content, timing, authorization and the medical record elements that meet the initial inpatient certification requirements. CMS also provided guidance on practitioner orders, including content, qualifications of ordering/admitting practitioner, verbal orders, “knowledge of the patient,” and timing and specificity of the order. The American Hospital Association expressed concerns with the policy and has asked for a six month delay so that the policy can be fully reviewed. On October 10, 2013, the New Jersey Hospital Association (NJHA) and HAP sent separate but similar letters to CMS on behalf of their members. St. Luke's University Health Network cosigned both letters.