PENNSYLVANIA’S “PRESCRIPTION FOR COVERAGE” WINDS ITS WAY THROUGH THE LEGISLATIVE PROCESS
Volume 28, Issue 494 June 25, 2007
Matthew Gever
In the waning days of Pennsylvania’s 2007 session, lawmakers are negotiating compromises on various proposals included in Governor Edward Rendell’s “Prescription for Pennsylvania,” a comprehensive effort, introduced in January, to increase access and improve the quality of care for all Keystone State residents.
The Governor’s plan was introduced in the General Assembly as HB 700, but given its breadth, lawmakers have divided elements into a series of separate bills. Some of those bills seek to rein in health-care costs and expand coverage by enlarging the scopes of practice of various health professionals, including certified registered nurse practitioners (CRNPs), pharmacists, nurse midwives, physicians’ assistants and dental hygienists.
“We are a state where lots of members in the medical profession cannot practice to the full extent of their training,” said Donna Cooper of the Governor’s Office of Policy and Planning in Pennsylvania. “One of our strategies for increasing access is really trying to make sure that those professionals can practice to the full extent of their training.”
But the Pennsylvania Medical Society warns that allowing “physician extenders” to practice without adequate physician oversight would backfire by threatening patient safety.
Introduced by Representative Tim Solobay, HB 1253 would lift some of the restrictions placed on CRNPs. “The care a CRNP is allowed to give should be limited only by his or her education and not by arbitrary guidelines,” said Representative Solobay.
Current Pennsylvania law provides that a physician may supervise no more than four nurse practitioners at once under a collaborative or written agreement. Among other things, the bill would lift those limits, and it would allow CRNPs to prescribe any drug, including controlled substances.
But after days of intense negotiations between the leadership of the House Professional Licensure Committee, gubernatorial representatives, and physicians’ and nurses’ associations, the bill was amended. The provisions to allow the nurses to prescribe any drug were struck, as was the measure to lift the limits on the number of CRNPs with whom a physician could collaborate.
The amended bill contains some of the provisions in the original bill. It would, for example, expand CRNPs’ scope of practice by allowing them to order durable medical equipment, as well as home health and hospice care. “We heard from an NP who was unable to order adult diapers for her patient because they are considered ‘durable medical equipment,’” said Patricia Schwabenbauer, president of the Pennsylvania Coalition of Nurse Practitioners.
The bill was voted out of the licensure committee, and the House might vote on it before the General Assembly recesses for the summer, sometime in July.
Expanding Access and Transparency
In addition to its scope of practice provisions, the Prescription would expand access by establishing a basic coverage package and offering it to all uninsured Pennsylvanians. The Commonwealth would define a basic benefit package, and Blues plans would be required to offer it (without any pre-existing condition exclusions) to small, low-wage employers, as well as uninsured, low-income adults.
The Commonwealth, employers and employees would share in the cost of coverage, with workers paying on a sliding, income-based scale. Those with incomes above 300 percent of the federal poverty level could obtain coverage but would receive no subsidies.
To pay for the subsidies, the state would establish the “Cover all Pennsylvanians” (CAP) fund. CAP would be funded by general revenues, federal dollars, and revenues from a new tax (defined as a percentage of wages paid by the employer) that would be levied on all employers that do not provide coverage. The Insurance Commissioner would control premium increases.
In an effort to help consumers make more informed choices about health-care services, the Prescription calls on the Health Care Cost Containment Council to establish three online price registries for pharmacies, hospitals and ambulatory surgery facilities.
© Copyright 2007, State Health Notes
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