WILKES-BARRE — State Rep. Aaron Kaufer this week said those who commit Medicaid fraud don’t just hurt the system, but those who depend on it most.
On Tuesday, the House passed Kaufer’s House Bill 2350 by a vote of 164-37. Kaufer said the legislation is part of a crucial Medicaid Fraud Reform bill package aimed at strengthening requirements for Medicaid providers, ensuring taxpayer funds are being used responsibly, providing stronger system oversight and making proper adjustments to the Medicaid system to increase its usefulness and reliability.
Kaufer’s bill would establish a requirement for providers in the Medical Assistance (MA) program who do not currently have a National Provider Identifier (NPI) through the federal government to obtain and register for a State Provider Identifier (SPI) through the Department of Human Services (DHS) in order to be reimbursed for providing services.
“Many Pennsylvanians rely on Medicaid in order to get the care they and their families need to maintain their health and well-being,” said Kaufer, R-Kingston. “The reform bills we put forward are necessary to repair our flawed system, restore the trust of dependents, and bring forth a new beginning to this program as we move to put in place stronger fraud penalties and increased program oversight.”
Kaufer said the package of bills is the direct result of a grand jury report on fraud in Pennsylvania’s Medical Assistance Program, also known as Medicaid, released by Attorney General Josh Shapiro’s office, and a report released late last year by the House Government Oversight Committee.
“As one of the top eight Medicaid spending states, Pennsylvania is the only one without a False Claims Act, which means we cannot comprehensively combat Medicaid fraud and recoup money lost,” AG Shapiro said. “A state False Claims Act and the reforms recommended by the grand jury that are being put forth today offer a dynamic, multi-faceted approach to fixing these problems.”
Kaufer’s legislation joins the other Medicaid bills as they will now be considered by the Senate.
Rep. Cartwright looks to
boost U.S. PPE production
U.S. Rep. Matt Cartwright, D-Moosic, this week announced that he will co-sponsor five pieces of legislation to bolster the American medical supply chain amid a nationwide coronavirus case surge that threatens to cause another shortage of personal protective equipment (PPE).
The coronavirus pandemic has exposed the United States’ heavy reliance on China for medical equipment. The latest annual report from the U.S.-China Economic and Security Review Commission showed that U.S. imports of Chinese medical equipment increased by 78 percent between 2010 and 2018. In that same time period, U.S. imports of Chinese pharmaceuticals increased by 76 percent.
“We can put the power of American industry and manufacturing to work on producing the lifesaving supplies needed to keep up the fight against the COVID-19 pandemic. An over-reliance on China and global supply chains for these items is a threat to our public health and national security,” Cartwright said. “These bills will enable American workers to help protect American lives.”
Cartwright is supporting five bills to promote the health, safety and security of the American people:
AG DePasquale supports
halting pharmacy ‘gag clauses’
Auditor General Eugene DePasquale this week applauded the General Assembly for sending House Bill 943 to the governor’s desk.
The bill would stop pharmacy benefit managers (PBMs) from imposing gag clauses on pharmacists, which can result in consumers paying more for their prescriptions.
“As I’ve warned for years, gag clauses ultimately prevent pharmacists from giving customers practical advice on how to save money on their prescriptions,” DePasquale said. “In some cases, consumers might save money by paying cash instead of using their insurance — but gag clauses stop pharmacists from volunteering that helpful advice unless a customer specifically asks.”
DePasquale has produced two special reports on PBMs, which act as middlemen between drug manufacturers and pharmacists. PBMs hold considerable power over the marketplace: they set reimbursement rates for pharmacists, collect rebates from drug manufacturers and often decide which medications are covered by insurance.
The nation’s three largest PBMs report billions of dollars in annual revenues. Pennsylvania taxpayers paid $2.86 billion to PBMs for services provided to Medicaid enrollees in 2017 alone, DePasquale noted, adding that there is too little transparency around how PBMs operate.
In January, DePasquale called for action on legislation to prohibit gag clauses and a separate bill that would give the Auditor General the ability to review contracts between PBMs and managed care organizations. That second bill is still awaiting action in the state Senate.
“Increasing the transparency of how PBMs operate and accountability for the tax dollars they receive could go a long way toward reducing the cost of prescriptions,” DePasquale said.
Independent pharmacists have long complained that rules imposed by PBMs, some of which have business relationships with large chain pharmacies, have made it hard for them to compete. Pennsylvania Pharmacists Association data show that dozens of independent pharmacies in Pennsylvania closed or were sold in the past 18 months.
Rep. Toohil supports broadband
funding during COVID-19 crisis
Rep. Tarah Toohil, R-Butler Township, has joined other female legislators from around the country in signing a letter seeking federal funding to help disadvantaged families pay for broadband service during the COVID-19 health emergency.
The letter was drafted by the Multicultural Media, Telecom and Internet Council (MMTC) and signed by National Foundation for Women Legislators (NFWL) board members.
Toohil currently serves as NFWL chair of international outreach.
“One of our concerns relating to the school closures resulting from COVID-19 has been the under-reporting of possible cases of child abuse,” Toohil said. “This program would allow social workers and teachers to stay connected with children and youth in their communities through an online link some families otherwise could not afford.”
Specifically, the letter asks the U.S. Congress to appropriate funding in the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act toward a program that would provide monthly vouchers for broadband service to qualifying low-income consumers for the duration of the pandemic.
The HEROES Act was passed by the U.S. House of Representatives in May and is currently under consideration in the U.S. Senate.
A public awareness campaign would be developed to inform consumers of support available to them through the broadband vouchers and other programs, such as the Lifeline, which provides a discount on phone service.
State releases information for
summer recreation, camps, pools
The Wolf Administration this week released updated frequently asked questions (FAQs) about summer recreation, camps and pools.
The original FAQs were announced on May 22 to cover summer camps and recreation. The new FAQs modify those and also add information about pools.
“As we learned more about the importance of mask-wearing and listened to questions from providers and parents, we updated the FAQs so everyone involved in these summer programs understands how they may operate,” Gov. Tom Wolf said. “We hope that this updated guidance helps everyone participating in summer child care and recreation programs and eliminates some of the stress and worry associated with the COVID-19 pandemic and how it is affecting our everyday lives.”
Highlights of the revised Summer Recreation, Camps and Pools FAQs include:
Regarding youth sports: Coaches, athletes and spectators must wear face coverings unless they are outdoors and can consistently maintain social distancing of at least six feet. Athletes are not required to wear face coverings while actively engaged in workouts and competition that prevent the wearing of face coverings, but must wear face coverings when on the sidelines, in the dugout, etc. and anytime six feet of social distancing is not possible.
Regarding summer program operations: If a summer program does not have a publicly available website, alternatives must be used to communicate the health and safety plan to parents and caregivers, such as mailing the plan to all registrants or having written information available at drop off and pick up locations.
Regarding face coverings for staff and participants in summer youth programs: All staff must wear face coverings during child care and summer program operations unless they fit one of the exceptions included in Section 3 of the Secretary of Health’s Universal Face Covering Order. Summer programs and staff should consult Department of Health guidance on homemade masks.
Regarding face coverings at pools: People should not wear cloth face coverings while engaged in activities that may cause the cloth face covering to become wet, like when swimming at the beach or pool. A wet cloth face covering may make it difficult to breathe./
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