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Lame Duck Session “Wrap Up” – Outstanding Victories
The Lame Duck Session has officially concluded. I am very happy to report that all the scope of practice expansion bills we were opposed to did NOT make it to the Governor’s Desk. Those bills as of January 8, 2024, received no further action. Most of those have been reintroduced in the new Legislative Session which is ongoing as of January 9, 2024.
January 16 at 5 pm was the last day bills on the Governor’s desk could be signed or face a pocket veto. More good news on that front. Two more of our key legislative priorities were signed into law, for a total of three bills where the efforts of the insurance industry to derail them were beaten back.
Many thanks to our leadership, board members, general membership and coalition partners for their support! Membership matters!
LEGISLATION TO PROHIBIT CREDIT CARD PAYMENTS BY INSURERS
A4913/S3133 Requires payers to offer health care providers’ reimbursement by all reasonably available methods of payment. The law becomes effective in 180 days, and applies to all coverage renewals after that date. Credit card payments cannot be the only method of payment offered. This is plainly stated in the law.
Current Status: Signed Into law on 1-8-2024
P.L. 2023, c.247
TRANSPARENCY IN PRIOR AUTHORIZATION REQUIREMENTS
A1255/S1794 Ensuring Transparency in Prior Authorization Act
This new law moves the needle in a major way. On all “peer to peer” reviews a reviewer must be in the same specialty as the physician requesting. The new tem frames are as follows:
- Medications: Under current law, PA requests for medications must be decided within 15 days. Under the bill, urgent PA requests for medications must now be decided within 24 hours. Non-urgent requests must be decided in 72 hours. The treating physician decides whether the request is urgent.
- Diagnostics and procedures: Under current law, insurers must decide PA requests within 15 days. Under the bill, urgent PA requests must be decided within 72 hours; non-urgent requests within nine days if submitted electronically, 12 if submitted on paper. Note: 72 hour turnaround can be decreased if required by medical exigencies of the case. Again, treating physician determines medical exigencies.
- Missed deadlines result in automatically approved PA requests.
- Chronic Conditions and Multiple Dates of Service: Where a PA has been granted for treatment of a chronic condition or for a defined series of services (e.g., chemotherapy course of treatment, psychotherapy sessions) no further PA is permitted for six months.
- In-Specialty Physician Review on Appeals: All denials on appeal must be issued by a physician who has Board certification in a specialty that treats the condition at issue, or the physician must have had experience treating the condition at issue within the last five years.
- Peer-to-Peer Right: Insurers must provide for a peer-to peer between the reviewing physician and treating physician, at the treating physician’s request, on any denial of an appeal.
- Insurer Reporting Requirements: Insurers must now report a host of statistics about their PA processes such as the tests/therapies that are subject to PA, approval/denial rates, reasons for denials, and various information about appeals.
- The new law takes effect on January 1, 2025.
This new law makes major strides in modifying prior authorization requirements.
Current Status: Signed into law on 1-16-2024 P.L. 2023, c.296
PAYMENT PARITY FOR TELE-HEALTH (One year extension)
A5757/S4127Revises Reimbursement Payments for provides using telemedicine and telehealth
Current Status: Signed into Law
BILLS THAT DID NOT REACH THE GOVERNOR’S DESK:
INDEPENDENT PRACTICE FOR APNs
S1522 A2296 Eliminates certain practice restrictions for advance practice nurses.
Current Status: No further action in Lame Duck Session
NURSE MIDWIVES NEW SCOPE AND LICENSING BOARD
S4042/A5674 Creates Midwifery Licensing Act
Current Status: No further action in Lame Duck Session
OPTOMETRIST SURGERY BILL
S3841/A5445- Updates scope of practice of optometrists
Current Status: No further action in Lame Duck Session
ATHLETIC TRAINERS - Scope Changes
A560/S135 – Revises the “Athletic Training Licensure Act”
Current Status: No further action in Lame Duck Session
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