LEG REG REVIEW 2015, 14th Issue *** May 4, 2015

LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol.  It contains news on the legislative and regulatory scene in Pennsylvania that may be of interest to the Insurance and Business Communities.  It is a free member benefit for those who are members of the Pennsylvania Association of Health Underwriters (PAHU).  Subscription information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/232-7005 or e-mail to xenobun@aol.com.  Please email jtrout2792@aol.com supplying both your name and e-mail address if you wish to be removed from or added to this list.



On May 1, Governor Tom Wolf sent a letter to US Department of Health & Human Services (HHS) Secretary Sylvia Burwell saying that Pennsylvania’s intent is to be re-classified as a state-based exchange.  PA would operate it but would retain the healthcare.gov operating platform.  He did so to let Federal regulators know that PA plans to have a contingency plan should the US Supreme Court rule that tax subsidies are no longer to be available in federally-facilitated marketplace states such as Pennsylvania.



Senate Bill 293 (Eichelberger-R-Blair) is up for consideration by the House Insurance Committee tentatively scheduled for May 11. The legislation would require navigators, certified application counselors and other ‘assisters’ to register with the PA Insurance Department and undergo a criminal background check. SB 293 passed the Senate earlier this year.  There will be an amendment authored by Minority Chair Tony DeLuca (D-Allegheny) allowing navigators et al to compare plans.  Movement of SB 293 was one of PAHU’s top priorities during the Association’s Day on the Hill April 21.



On April 27, Governor Wolf announced the successful transition of 121,234 individuals from former Governor Corbett’s Healthy PA program to the traditional Medicaid program.  Authorized by the Patient Protection Affordable Care Act (PPACA), Corbett had sought to increase Medicaid eligibility via a private sector-oriented plan.  The Wolf action reverses that.  There are 137,723 individuals still enrolled in the PA Private Coverage Option (PCO) — Corbett’s plan — but the Wolf Administration says that these PCO recipients will be completely transitioned by September.



The Office of the Attorney General and the Wolf Administration filed a motion in Commonwealth Court regarding the Consent Decree negotiated by former Governor Tom Corbett with Highmark and UPMC.  At issue is the decision by UPMC not to allow in-network coverage for holders of Highmark’s Medicate Advantage plan.  If agreed to by the Court, mandatory arbitration would address the contractual dispute between the two Pittsburgh-based parties.  In announcing the action, Governor Wolf said “Consumers including seniors and people with cancer have had enough and the games between UPMC and Highmark must end.”


UPMC had a different take:   The Consent Decrees entered with the Commonwealth on July 1, 2014, explicitly contemplated this possibility, giving UPMC the right to withdraw from its Medicare Advantage arrangements with Highmark if Highmark “should take the position that it has the authority to revise the rates payable under those arrangements unilaterally and materially.” Several months ago UPMC notified the Commonwealth that Highmark had triggered UPMC’s right to withdraw from those arrangements by repeatedly asserting that argument and by continuing to underpay UPMC for its medical services. UPMC has elected to make this withdrawal effective January 1, 2016, so as not to interrupt services for the current program year. This action has no impact for the rest of 2015 on those seniors who are currently Highmark Medicare Advantage members. Other than Highmark Community Blue Medicare HMO members, who have never had in-network access, all other Highmark Medicare Advantage members can continue to use all UPMC physicians and facilities on an in-network basis through December 31, 2015.



  • On May 5 the Joint Legislative Budget & Finance Committee is meeting to discuss awarding a contract to study the issue of school benefit program consolidation into one state-run entity.  This is done per Senate Resolution 250 of 2013.  PAHU opposes such consolidation.
  • On May 6, the House Aging & Older Adult Services Committee plans an informational meeting with AARP to hear its legislative priorities.
  • Also on May 6, the Senate Public Health & Welfare Committee will take up Senate Bill 396 (Vance-R-Cumberland) which would re-authorize the PA Health Care Cost Containment Council (PHC4).
  • The Senate Finance Committee confirmation hearing for Acting Revenue Secretary Eileen McNulty originally set for May 6 has been postponed to a later  date TBA.



July 6, 2015 is the last date comments will be accepted for the US Department of Labor’s proposed fiduciary responsibility rule for financial advisors including advice given to 401(k) and IRA investors.  According to the DOL, the Rule would require retirement investment advisors and their firms to formally acknowledge fiduciary status and enter a contract in which they commit to standards of impartial conduct, that is, giving advice that is in the customer’s best interest.  The proposal also asks for comment on a new ‘low-fee’ exemption that would allow firms to accept conflicted payments when recommending the lowest-fee product.  On April 21, the National Association of Insurance & Financial Advisors (NAIFA), the National Association of Fixed Annuities, the American Bankers Association and 13 other associations asked for an extension on the comment period saying that the industry needs more time to review the proposed Rule given its impact to require “significant changes in policies and practices, as well as the production of expansive new disclosure.”  Details: www.dol.gov/ebsa/regs/confkictsofinterest.html.



The US Department of Health & Human Services (HHS) issued patient evaluations of US hospitals including 158 in Pennsylvania on a one to five scale.  Nationally, 251 hospitals received a five; PA had eight.  Overall, PA scored 3.2 out of five which means that 36 states did better.  These ratings were based on patient reviews.  Details:  www.medicare.gov/hospital compare



The PA Insurance Department issued its annual score card on 2014 testing results for producer licenses.

Test                             # Candidates               Overall Pass Rate

Life                             3,256                           55.4%

Accident/Heath           1,691                           49.4%

L/A/H                          3,980                           60.4%

Property Casualty       2,637                           51%

Personal Lines             93                                28.7%

Surplus Lines              35                                91.3%



–          On July 1st, the PA Insurance Department will transfer CE responsibilities from Maryland-based PROMETRIC to PSI for licensing exams and continuing education.  SIRCON will continue to be the database where credits are posted and transcripts are obtained. Provider, Course & Instructor reviews will be completed by Risk Management Solutions of America, Inc. (RMSA) Provider Course and instructor audits will be completed by Absolute Staffing & Consulting Services, LLC

–          Costs are consistent with: $5.00 per person for roster submissions for CE and pre-licensing; CE and pre-licensing provider applications and renewals $20.00; Course application for CE and pre-licensing are $30.00; Instructor applications are $10.00.

Provider and Producer Information Packets should be available at www.psiexams.com

You May Also Like…

PA-NABIP Pulse June 2024

PA-NABIP Pulse June 2024 The Facts of the Month Here is something to mention when discussing health trends in the...

PA-NABIP Pulse May 2024

The Facts of the Month Here is something to mention when discussing coverage trends in the month ahead. While the...

PA-NABIP Pulse April 2024

The Facts of the Month Here is something to mention when discussing coverage trends in the month ahead. Twenty-three...