Frustrated by Insurance Issues? CRSO and PRS can help
Many of us are affected by payer policies that impact our ability to provide the best care for our patients, and the Coalition of State Rheumatology Organizations (CSRO) can help. They launched a new resource for rheumatologists to request assistance from CSRO in addressing payer issues impacting their patients and practices. This new form enables them to act quickly to help resolve your concern, whether by supplying template letters for your practice, writing, or calling on your behalf, or directing you to other known resources.
You can find the form under the Resources tab on CSRO’s website or by clicking here.
Our state society is proud to be a member of CSRO, and if CSRO can support you in other ways, or you have questions about the new online form or webinar, please contact their Executive Director Ann Marie Moss with suggestions at amoss@csro.info.
You can find the form under the Resources tab on CSRO’s website or by clicking here.
Our state society is proud to be a member of CSRO, and if CSRO can support you in other ways, or you have questions about the new online form or webinar, please contact their Executive Director Ann Marie Moss with suggestions at amoss@csro.info.
Celebrating beginnings and endings
Paul Killian, MD PRS Advocacy Chair and Deborah Ann Shoemaker, PRS outside lobbyist
What is more exciting- the beginning or an ending? Whichever you prefer, this year will be a year of endings- the final year of a two-year legislative session; the end of the tenure of Governor Tom Wolf; hopefully, a more significant end and/or slowing of the COVID-19 epidemic. As we approach these significant changes, there are opportunities to celebrate beginnings and/or new opportunities. In our quarterly column, we will update our members of our past activities and areas for celebrating new beginnings.
End of an Era: Dr. Paul Killian, Advocacy Chair
New Opportunities: Seasoned Guidance and Transition
As we write this column, this year has already brought significant changes for our Society. Over the years, we have experienced changes in PRS staff, PRS leadership and PRS advocacy work. Deborah Ann Shoemaker, our lobbyist, is now working as an independent contractor, dedicated more than ever to advancing our grassroots advocacy efforts at the federal and state level. She will be working at the direction of PRS leadership to ensure our mission is being advanced in the most appropriate way to important stakeholders who can affect the daily practice of rheumatology.
However, as your lobbyist, I would be remiss to inform you that the announcement that Dr. Killian would like to step down as PRS Advocacy Chair to focus on his retirement was bittersweet. His knowledge and tireless dedication to his patients, and to the profession of rheumatology is legendary. Although he served as PRS president many years ago, he continued to advocate for the profession by getting involved with organized medicine both in and out of rheumatology (including the American College of Rheumatology [ACR], Coalition for State Rheumatology Organizations [CSRO], and the Pennsylvania Medical Society [PAMED]). When the Society decided to formally join CSRO, or contract with PAMED for more formal grassroots lobbying services, Dr. Killian served a crucial role in guiding our leadership. Dr. Killian’s contributions to the Society are endless, of which we will be forever grateful.
That being said, new beginnings can bring a new perspective... a fresh look into what priorities are important to our membership- scope of practice expansion, cost containment initiatives, reduction of administrative barriers to perform the daily clinical practice of rheumatology, reduced barriers to obtaining quality care and access to medications for our patients, and the list goes on forever. Rest assured, we will continue to work with PRS leadership, our colleagues at ACR and CSRO and our medical specialty colleagues to ensure our voice is heard as part of the uniform house of medicine. If you possess an interest to get involved as PRS advocacy chair, to serve on the PRS advocacy committee or to be involved in any grassroots advocacy for the Society, please do not hesitate to let us know.
End of an Era: Governor Wolf Administration
New Opportunities: Advocate for Sustainability for Medicine and/or the Need for Change
It is hard to believe that almost eight years have passed since Governor Tom Wolf began his tenure as governor of Pennsylvania. Regardless of your opinion on how his administration fared on the key issues placed before him, being governor (or any leader within the United States or across the world), over the last eight years has been challenging. COVID-19 changed everything- politically, socially, emotionally- even the daily practice of medicine. Over the past two years, specifically during federal and state Public Health Emergency (PHE) declarations, technical advances such as the widespread usage/insurance coverage of telehealth and reduction of barriers to care (including temporary lifting of prior authorizations, waivers in state licensure requirements, and reduction of supervision ratios- just to name a few) have assisted greatly in ensuring that quality and the continuity of care for your patients would continue without interruption. Some other healthcare victories achieved during the Wolf Administration included the creation of a statewide Prescription Drug Monitoring Program to assist in obtaining a more complete patient medication profile, temporary reprieves from reinstituting waivers relaxed during the COVID-19 epidemic; enactment of informed consent legislation; stoppage of proposed malpractice change of venue legislation; and using federal pandemic American Rescue Funding Plan (ARFP) to increase funding for direct care workers and other related workforce initiatives for hospitals and healthcare facilities across the commonwealth.
So, what does the end of this era mean for PRS? This gives our Society, and all interested stakeholders representing the practice of medicine, the opportunity to advocate for what is important to our members and our patients with both the current administration and our future governor. The primary elections are decided on May 17th. After those races are determined, all prospective candidates for the elected offices of governor, lieutenant governor, United States Senator (for retiring United States Senator Pat Toomey’s seat), certain United State Congressional seats and various state House and Senate seats will be in a six-month frenzy to win over voters with promises of being the best candidate for political office. During this exciting time of transition, we will look for opportunities to join with our colleagues in advancing important areas of priority for the practice of medicine. As information is available, we will distribute them to our membership or put it on the website.
End of a Legislative Cycle: 2021-2022 legislative session
New Opportunities: Advocate for current legislative initiatives/look to the future
The Pennsylvania state legislature runs on a two-year legislative cycle. After that timeframe has ended, all proposed legislation not enacted upon must be reintroduced in the upcoming session for future consideration. Only a fraction of the thousands of proposed bills introduced ever see the light of day. Although those statistics can be frustrating at best, getting your issue even proposed is an accomplishment. The Society has been tracking proposed legislative initiatives of priority to our membership, along with areas that we hold a supportive role in advancing grassroots efforts. Copies of our most recent tracking report and legislative update are enclosed.
Our Society’s current areas of legislative priority include:
Although it is our desire to have our top grassroots lobbying issues enacted during this legislative session, we will be vigilant in advancing these important issues regardless of the timeframe it takes to be successful.
In closing, we started this article asking your preference- a beginning or an ending. What are we missing? The middle! As a middle child, I know the importance that the middle has to the entire process. Without a middle, there is no beginning or end. The middle, in essence, is that transition period to bigger and better things. Working in the middle of a project, or advancing a priority requires the middle to reevaluate the game plan, or to revise the agenda, in essence to be patient with the process and see it through. For our federal partners at ACR or CSRO, we are the “middle”- the go-between between state and federal partners. For our state partners at PAMED, we are the “middle”- the glue between our members and their physician members who specialize in rheumatology.
Where do PRS members fit into this process? Be the middle, willing to assist our leadership, our advocacy committee and our lobbyist when necessary to providing your clinical expertise to perform grassroots lobbying. If you are willing to be the middle, please contact PRS.
Enjoy the end of this unpredictable winter, looking for new spring opportunities.
What is more exciting- the beginning or an ending? Whichever you prefer, this year will be a year of endings- the final year of a two-year legislative session; the end of the tenure of Governor Tom Wolf; hopefully, a more significant end and/or slowing of the COVID-19 epidemic. As we approach these significant changes, there are opportunities to celebrate beginnings and/or new opportunities. In our quarterly column, we will update our members of our past activities and areas for celebrating new beginnings.
End of an Era: Dr. Paul Killian, Advocacy Chair
New Opportunities: Seasoned Guidance and Transition
As we write this column, this year has already brought significant changes for our Society. Over the years, we have experienced changes in PRS staff, PRS leadership and PRS advocacy work. Deborah Ann Shoemaker, our lobbyist, is now working as an independent contractor, dedicated more than ever to advancing our grassroots advocacy efforts at the federal and state level. She will be working at the direction of PRS leadership to ensure our mission is being advanced in the most appropriate way to important stakeholders who can affect the daily practice of rheumatology.
However, as your lobbyist, I would be remiss to inform you that the announcement that Dr. Killian would like to step down as PRS Advocacy Chair to focus on his retirement was bittersweet. His knowledge and tireless dedication to his patients, and to the profession of rheumatology is legendary. Although he served as PRS president many years ago, he continued to advocate for the profession by getting involved with organized medicine both in and out of rheumatology (including the American College of Rheumatology [ACR], Coalition for State Rheumatology Organizations [CSRO], and the Pennsylvania Medical Society [PAMED]). When the Society decided to formally join CSRO, or contract with PAMED for more formal grassroots lobbying services, Dr. Killian served a crucial role in guiding our leadership. Dr. Killian’s contributions to the Society are endless, of which we will be forever grateful.
That being said, new beginnings can bring a new perspective... a fresh look into what priorities are important to our membership- scope of practice expansion, cost containment initiatives, reduction of administrative barriers to perform the daily clinical practice of rheumatology, reduced barriers to obtaining quality care and access to medications for our patients, and the list goes on forever. Rest assured, we will continue to work with PRS leadership, our colleagues at ACR and CSRO and our medical specialty colleagues to ensure our voice is heard as part of the uniform house of medicine. If you possess an interest to get involved as PRS advocacy chair, to serve on the PRS advocacy committee or to be involved in any grassroots advocacy for the Society, please do not hesitate to let us know.
End of an Era: Governor Wolf Administration
New Opportunities: Advocate for Sustainability for Medicine and/or the Need for Change
It is hard to believe that almost eight years have passed since Governor Tom Wolf began his tenure as governor of Pennsylvania. Regardless of your opinion on how his administration fared on the key issues placed before him, being governor (or any leader within the United States or across the world), over the last eight years has been challenging. COVID-19 changed everything- politically, socially, emotionally- even the daily practice of medicine. Over the past two years, specifically during federal and state Public Health Emergency (PHE) declarations, technical advances such as the widespread usage/insurance coverage of telehealth and reduction of barriers to care (including temporary lifting of prior authorizations, waivers in state licensure requirements, and reduction of supervision ratios- just to name a few) have assisted greatly in ensuring that quality and the continuity of care for your patients would continue without interruption. Some other healthcare victories achieved during the Wolf Administration included the creation of a statewide Prescription Drug Monitoring Program to assist in obtaining a more complete patient medication profile, temporary reprieves from reinstituting waivers relaxed during the COVID-19 epidemic; enactment of informed consent legislation; stoppage of proposed malpractice change of venue legislation; and using federal pandemic American Rescue Funding Plan (ARFP) to increase funding for direct care workers and other related workforce initiatives for hospitals and healthcare facilities across the commonwealth.
So, what does the end of this era mean for PRS? This gives our Society, and all interested stakeholders representing the practice of medicine, the opportunity to advocate for what is important to our members and our patients with both the current administration and our future governor. The primary elections are decided on May 17th. After those races are determined, all prospective candidates for the elected offices of governor, lieutenant governor, United States Senator (for retiring United States Senator Pat Toomey’s seat), certain United State Congressional seats and various state House and Senate seats will be in a six-month frenzy to win over voters with promises of being the best candidate for political office. During this exciting time of transition, we will look for opportunities to join with our colleagues in advancing important areas of priority for the practice of medicine. As information is available, we will distribute them to our membership or put it on the website.
End of a Legislative Cycle: 2021-2022 legislative session
New Opportunities: Advocate for current legislative initiatives/look to the future
The Pennsylvania state legislature runs on a two-year legislative cycle. After that timeframe has ended, all proposed legislation not enacted upon must be reintroduced in the upcoming session for future consideration. Only a fraction of the thousands of proposed bills introduced ever see the light of day. Although those statistics can be frustrating at best, getting your issue even proposed is an accomplishment. The Society has been tracking proposed legislative initiatives of priority to our membership, along with areas that we hold a supportive role in advancing grassroots efforts. Copies of our most recent tracking report and legislative update are enclosed.
Our Society’s current areas of legislative priority include:
- advancement of proposed legislation to prevent Accumulator Adjustment Programs within certain state regulated plans (House Bill 1644 and Senate Bill 196);
- advancement of proposed legislation to reduce unfair methods of competition when determining medication costs and/or insurance coverage of prescription medications [also known as non-medical switching] (House Bill 599 and Senate Bill 828); and
- advancement of proposed legislation to reduce administrative burdens and/or barriers to prior authorization requirements by insurers (House Bill 225 and Senate Bill 225).
Although it is our desire to have our top grassroots lobbying issues enacted during this legislative session, we will be vigilant in advancing these important issues regardless of the timeframe it takes to be successful.
In closing, we started this article asking your preference- a beginning or an ending. What are we missing? The middle! As a middle child, I know the importance that the middle has to the entire process. Without a middle, there is no beginning or end. The middle, in essence, is that transition period to bigger and better things. Working in the middle of a project, or advancing a priority requires the middle to reevaluate the game plan, or to revise the agenda, in essence to be patient with the process and see it through. For our federal partners at ACR or CSRO, we are the “middle”- the go-between between state and federal partners. For our state partners at PAMED, we are the “middle”- the glue between our members and their physician members who specialize in rheumatology.
Where do PRS members fit into this process? Be the middle, willing to assist our leadership, our advocacy committee and our lobbyist when necessary to providing your clinical expertise to perform grassroots lobbying. If you are willing to be the middle, please contact PRS.
Enjoy the end of this unpredictable winter, looking for new spring opportunities.
Before you hang your head and put your hands up in despair, there are few lights at the end of this tunnel. First off, if you are a DHS-enrolled provider, it appears that they intend to continue the ability to perform telemedicine for their enrollees. Specifically, the Office of Mental Health and Substance Use Services (OMHSAS) unveiled an updated Bulletin in late August to address the use of telemedicine after the PHE has ended in the commonwealth. Although there are some clarifications being asked of the Department related to use of audio-only telemedicine and payment, it appears that DHS is dedicated to retaining the use of telehealth and limit the disruption of treatment and services for their enrolled consumers.
A copy of the update telemedicine bulletin is added here.
As chair of DHS’ Office of Medical Assistance Programs’ Medical Assistance Advisory Committee (MAAC), I intend to keep on top of initiatives and policy changes that affect how you provide crucial, often life-sustaining services to individuals and families across the commonwealth.
In closing, our colleagues at PAMED, along with various coalition partners, are taking the lead on grassroots advocacy efforts. PRS is involved in many of these coalition meetings to reinforce those key initiatives must remain in place to ensure that our patients do not have a disruption of service or face additional barriers in obtaining care. In the meantime, please do not hesitate to contact me at dshoemaker@pamedsoc.org or via phone at 717.909.2689 with any questions, clarifications, concerns, or additional information as we navigate this new complicated world after September 30th.
You are not alone. The Society will continue to fight for you during this difficult time.
A copy of the update telemedicine bulletin is added here.
As chair of DHS’ Office of Medical Assistance Programs’ Medical Assistance Advisory Committee (MAAC), I intend to keep on top of initiatives and policy changes that affect how you provide crucial, often life-sustaining services to individuals and families across the commonwealth.
In closing, our colleagues at PAMED, along with various coalition partners, are taking the lead on grassroots advocacy efforts. PRS is involved in many of these coalition meetings to reinforce those key initiatives must remain in place to ensure that our patients do not have a disruption of service or face additional barriers in obtaining care. In the meantime, please do not hesitate to contact me at dshoemaker@pamedsoc.org or via phone at 717.909.2689 with any questions, clarifications, concerns, or additional information as we navigate this new complicated world after September 30th.
You are not alone. The Society will continue to fight for you during this difficult time.
Tracking List & Council Report
March 24, 2022
General Assembly Session Dates
2022 HOUSE SESSION SCHEDULE
March 21, 22, 23, 28, 29, 30
April 11, 12, 13, 25, 26, 27
May 23, 24, 25
June 7, 8, 9, 13, 14, 15, 20, 21, 22, 23, 24, 27, 28, 29, 30
September 12, 13, 14, 19, 20, 21
October 24, 25, 26
November 14, 15, 16 2022
SENATE SESSION SCHEDULE
March 28, 29, 30
April 4, 5, 6, 11, 12, 13
May 23, 24, 25
June 6, 7, 8, 13, 14, 15, 20, 21, 22, 23, 24, 27, 28, 29, 30
March 21, 22, 23, 28, 29, 30
April 11, 12, 13, 25, 26, 27
May 23, 24, 25
June 7, 8, 9, 13, 14, 15, 20, 21, 22, 23, 24, 27, 28, 29, 30
September 12, 13, 14, 19, 20, 21
October 24, 25, 26
November 14, 15, 16 2022
SENATE SESSION SCHEDULE
March 28, 29, 30
April 4, 5, 6, 11, 12, 13
May 23, 24, 25
June 6, 7, 8, 13, 14, 15, 20, 21, 22, 23, 24, 27, 28, 29, 30
PRS LEGISLATIVE PRIORITIES |
ADDITIONAL RESOURCES |
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