Legislative Issues that affect your practice

Pennsylvania’s Medicaid State Plan and Medical Assistance Program Add Interprofessional Consultation (e-consults) Services to the Fee Schedule

Beginning on January 1 2024, Pennsylvania healthcare professionals can begin seeking reimbursement for electronic interprofessional consultations for patients covered under the Medical Assistance and CHIP programs. The Department of Human Services will announce further details in the New Year.

View the Infographic

2022 PA Primary Election Overview

The Pennsylvania primary election is shaping up to be one of the most interesting in quite some time. There are 39 incumbents that are facing challengers. Additionally, there are eight candidates vying for the Republican Gubernatorial nomination. The winner will face Attorney General Josh Shapiro in the fall.

In separate documents you will find overviews of the Governor’s and legislative races for your information. The intent is to give you background and not an endorsement. We realize the legislative overview is rather lengthy and have organized it by region so that you may go to your section to view the races.

View the Governor's race overview

View the Legislative races overview

Please feel free to direct any questions to Tim Bittle, [email protected], regarding the documents or if you need additional background.

Major Legislative Victory Reverses Court-Imposed Informed Consent Rules

On June 25, 2021 the state House of Representatives unanimously passed SB 425. This important legislation corrects the Pennsylvania Supreme Court’s ruling in Shinal v. Toms that restricted a treating physician’s ability to delegate patient informed consent acquisition to another qualified medical team member. The state Senate passed SB 425 on a 47 – 0 vote in April. Governor Wolf is expected to sign the bill within the next ten days.

PAOrtho participated in the Shinal v. Toms litigation with an amicus brief, but we were disappointed with the adverse outcome. SB 425 provides orthopaedic surgeons and all physicians long sought legislative relief from the adverse effects of Shinal v. Toms while protecting patients’ rights to have questions answered by their treating physicians. The bill has an immediate effective date, but PAOrtho recommends you seek guidance from counsel or your institution before you begin to delegate acquisition of informed consent.

Our Society is grateful to Senate Majority Whip John Gordner (R, Columbia) for leading the effort for a legislative remedy to this vexing MCare Act issue.

Preauthorization and Fail First/Step Therapy Legislation Advances

On June 23, 2021 the state Senate Banking and Insurance Committee amended and voted in favor of SB 225 on unanimous votes. This vital legislation will curtail healthcare insurers’ excessive preauthorization and step therapy practices. PAOrtho leads the patient advocate/healthcare provider organization coalition that brought the issue to this successful vote.

PAOrtho thanks committee Chair John DiSanto (R, Dauphin) and bill sponsor Senator Kristin Phillips-Hill for their leadership in advancing this critical issue. The Society will continue to advocate for fall enactment of SB 225.

Press Conference on Prior Authorization on May 23, 2021

PAOrtho Board member and VP of Medical Affairs at OSS Health, Dr. Suzette Song, represented the Society at yesterday's press conference on prior authorization in Harrisburg.

If passed, SB 225 and HB 225 would curb restrictive prior authorization and stop fail first practices.

Our thanks to Dr. Song for serving as MC of the event and discussing this critical issue in her pre-press conference interview with ABC27. View the news story & interview here, or click below


Dr. Suzette Song Advocates for Legislation to Curb Health Insurers' Prior Authorization and Step Therapy Practices

View Dr. Song's OpEd


Board of Directors Meeting

Board members meet with Speaker of the House Bryan Cutler and House Majority Leader Kerry Benninghoff in Harrisburg to discuss legislative issues affecting PAOrtho members. 

McCarran-Ferguson Repeal Subjects Insurers to Antitrust Laws

In the waning days of the 116th Congress and the Trump Administration, organized medicine achieved a major legislative victory. The long-sought McCarran-Ferguson repeal subjecting healthcare insurers to antitrust laws cleared the Congress in late December and was signed into law by President Donald Trump on January 13, 2021. 

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PAOrtho Notches Second Litigation Victory Protecting Orthopaedic Surgeons

The stakes could not be higher.  Can a surgeon present expert testimony regarding risks and complications in a medical liability case?  For the second time in two years, that question was before the Pennsylvania Supreme Court.  And for the second time, PAOrtho entered the litigation fray and led the charge to defeat the trial lawyers attempting to diminish your right to defend yourself.

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Vote No on AAOS Bylaw Amendments Groups 1 & 2

The AAOS bylaw amendment process is completed. The Fellowship voted and Bylaw Amendment Groups 1 and 2 were not adopted. The Society thanks PAOrtho members for your engagement on these issues.

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Excessive Prior Authorization

PAOrtho Responds with Legislation

Healthcare insurers’ excessive prior authorization demands have fundamentally altered healthcare delivery. Routine and common diagnostic and treatment options are now subject to prior authorization, delaying care and jeopardizing the patient/physician relationship. Insurers’ third-party administrators further separate patients from the care their premium dollars are designed to provide. Unabated and unreasonable prior authorization threatens to undermine the healthcare delivery system.

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Venue Shopping

PA Orthopaedic Society: Medical Liability Venue Shopping Would Hike Costs, Threaten Care

The possible return of medical liability venue shopping, in a proposal now moving behind the scenes at the Pennsylvania Supreme Court, threatens to plunge Pennsylvania into a crisis that could drive up medical liability insurance premiums while forcing medical professionals to leave the state.

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Mitchell v Shikora - A Major Judicial Victory Achieved!

Led by PAOrtho and PAMED, all physicians gained a major judicial victory as the Pennsylvania Supreme Court issued its ruling in Mitchell v Shikora.  In the Mitchell case, the state Superior Court ruled on 6/18/2019 that expert witness testimony on surgical risks and complications in medical liability litigation was too prejudicial for a jury to hear.  This incomprehensible decision flew in the face of decades of Pennsylvania jurisprudence and deprived surgeons of a major medical liability defense and would ultimately result in another liability insurance crisis in our state.  The state Supreme Court wisely reversed the Superior Court’s decision. 

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What You Need to Know About PA Act 96

Mandatory Electronic Controlled Substance Prescriptions

Summary and Implementation Guidelines



PAOrtho also successfully killed Governor Tom Wolf’s proposed ambulatory surgical center (ASC) tax for the third straight year. This tax would be imposed on ASC around the state and would disproportionately effect outpatient surgeries, and in particular Orthopaedic surgeries.

Opioid Legislation

PAOrtho has helped achieve a surgical exception in SB 112, which is legislation designed to impose a seven-day opioid prescribing limit. This exception would allow Orthopaedic surgeons to maintain greater flexibility in patient care and facilitate greater convenience for our patients.

Also related to opioid abuse, PAOrtho applied for and received a $250,000 opioid education state grant. These funds will be used in various educational endeavors, including an Opioid Symposium at the November CME meeting in Philadelphia.