Advisory: Information about available COVID-19 outpatient therapeutics

Type: AdvisoryDescription of Advisory: Information about available COVID-19 outpatient therapeuticsSource Organization: NYSDOHAuthorizing Person: Deputy Commissioner, NYSDOHSender’s Jurisdiction: StateNotification ID: 107774Date of Advisory: 12/27/2021

COVID-19 ORAL ANTIVIRAL TREATMENTS AUTHORIZED AND SEVERE SHORTAGE OF ORAL ANTIVIRAL AND MONOCLONAL ANTIBODY TREATMENT PRODUCTS

This announcement is to make you aware of information about available COVID-19 outpatient therapeutics, including newly authorized oral antiviral treatments. Two COVID-19 oral antiviral therapies have received Emergency Use Authorization from the U.S. Food and drug Administration (FDA), Paxlovid (Pfizer) and molnupiravir (Merck). In addition there is information pertaining to updated guidance, including on treatment supply and prioritization for monoclonal antibodies and oral antivirals.

Recipients:All PharmacistsAll PrescribersDiagnostic and Treatment CentersHealthcare AssociationsHospitalsNursing HomesRoles:County DOH – 24/7 Urgent Communicable Disease ContactCounty DOH – Commissioner/Public Health DirectorCounty DOH – Director, Disease ControlCounty DOH – Director, Patient ServicesCounty DOH – Lead EpidemiologistCounty DOH – Medical DirectorCounty DOH – On-Duty Public Health OfficerCounty DOH – Public Health Preparedness – Contact B, EpidemiologyCounty DOH – Public Health Preparedness – Primary ContactFor questions: Please send an e-mail to COVID19therapeutics@health.ny.gov, as notify01 is a non-monitored mailbox.

Medical Society Supports Gov’s Plans for State COVID-19 Mandate for School-Aged Children

For Immediate Release
December 21, 2021 

Medical Society Supports Gov’s Plans for State COVID-19 Mandate for
School-Aged Children

Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York  

“In recent press interviews, Governor Hochul said she plans to seek approval from the NYS Legislature to require COVID-19 vaccines for all school-aged children. The Medical Society of the State of New York supports the Governor in her efforts and supports mandatory COVID-19 vaccination among all school-aged children.

“Vaccinating our school-aged children is yet another step towards getting this pandemic under control. We once again encourage school-aged children to get vaccinated and adults to get vaccinated and boosted against COVID-19.”

# # #

About MSSNY
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

Media Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

MSSNY eNews: December 22, 2021


.

THIS IS THE LAST ENEWS PUBLICATION BEFORE THE HOLIDAY.
WE WILL RETURN ON WEDNESDAY, JANUARY 5.

WISHING ALL OF OUR MEMBERS A HAPPY AND HEALTHY 2022!

Digital Holiday Card


COVID-Related Stress and Work Intentions in a Sample of U.S. Health Care Workers
A new Mayo Clinic Proceedings article led by the American Medical Association explores the relationship between COVID-related stress and work intentions of U.S. health care workers. The article found that physicians, nurses, and advanced practice providers are at the highest risk of reducing clinical work hours or leaving their practice, with one in five physicians and two in five nurses intending to leave their practice altogether.

Factors associated with a greater intention to reduce work hours or leave a practice include higher levels of burnout, stress, workload, fear of infection, anxiety or depression due to COVID-19, and the number of years in practice. The article concluded that organizations should implement measures to enhance health care workers’ sense of value, create supportive environments, and reduce work overload through better teamwork to reduce stress and prevent turnover.


MLMIC Ad


Federal Law Restricting Patient Surprise Bills Takes Effect January 1:
Be Prepared
As reported in recent MSSNY eNews articles, the New York Department of Financial Services has issued a lengthy advisory letter detailing how it intends to reconcile potentially conflicting provisions between the federal No Surprises Act that takes effect January 1, and New York’s surprise bill law provisions.  The letter discusses that New York’s law will now:

  • Ensure that that the provisions of New York’s surprise bill law will apply to all out of network providers, not just hospitals and physicians;
  • Clarify that the “visit” subject to patient protection under New York’s surprise bill law includes: equipment and devices, telemedicine services, imaging services, laboratory services, preoperative and postoperative services, and other such services as HHS may specify;
  • Clarify that New York’s surprise bill law applies to all safety net hospitals;
  • Clarify that previously exempted CPT codes 99281 – 99285, 99288, 99291 – 99292, 99217 – 99220, 99224 – 99226, and 99234 – 99236 are no longer exempted from NY’s surprise bill law;
  • Clarify that the insured’s cost-sharing will be calculated based upon the health insurer’s initial payment amount to the physician, hospital or other care provider
  • Clarify that patients cannot be asked to waive protections for both emergency and surprise out of network bills
  • Clarify that, even if a patient does not sign an assignment of benefits form, upon receipt of a claim from a provider for a surprise bill or for emergency services, an issuer must send the initial payment or notice of denial of the payment directly to the provider
  • Remind health care providers of the federal NSA requirement to post on their website and in their practice location a New York-specific model form advising their insured patients of their legal protections against surprise medical bills.

This is just one of numerous federal patient protections that will become effective on January 1.  Litigation has been filed by various medical and hospital associations against one aspect of the federal No Surprises Act relative to the consideration of various data points during an independent dispute resolution between an out of network health care provider and health insurer.

MSSNY’s General Counsel, Garfunkel Wild, P.C., has announced the creation of a Federal Surprise Bill Working Group that has developed a particular level of expertise in addressing client questions about the new Federal No Surprises Act law.

Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact info@garfunkelwild.com.


Governor to Sign Legislation to Limit Formulary Adjustments
Governor Hochul will be signing into law legislation (S.4111, Breslin/A.4668, People-Stokes) advocated for by MSSNY and several other patient advocacy groups that will greatly limit the ability of health insurers to implement prescription formulary changes or cost-sharing tier changes for medications during the middle of a policy year.  Based upon some technical amendments agreed to by the State Legislature, the law will take effect for policy years that begin January 1, 2023 and after.

We thank the many physicians who took the time to send a letter to Governor Hochul urging her to sign this bill into law.  Still pending before Governor Hochul is legislation also supported by MSSNY that would regulate the practices of Pharmaceutical Benefit Managers (PBMs).

Governor Hochul has signed into law another bill (A.1677, Gottfried/S.2008, Jackson) supported by MSSNY that requires health insurers to provide greater details to a physician or hospital when a claim has been partially approved, as opposed to being denied.


Membership Renewal Banner


UnitedHealthcare Offers New Process to Expedite Claims
UnitedHealthcare is now offering a new process to better serve care providers in a more responsive and efficient way.  It will expedite both the handling and accuracy of claims.  They now have a dedicated team of individuals that includes claims processors assigned to handle all open claims issues.

With this new process, your unresolved claims issues will be quickly resolved by a dedicated and experienced claims reviewer who will respond with the resolution or a status usually within 2 days.   When you have a claims question or dispute that was not resolved to your satisfaction through the service model (e.g., LINK reconsideration, call center or appeal) you now can utilize their dedicated team to handle your escalated issues by sending an email to NewYork_PR_Team@uhc.com.   By sending issues as soon as they are identified, your issues will be resolved without further delay.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | hlopez@mssny.org.


Mark Your Calendars: MSSNY’s Virtual Lobby Day is on March 8th
Please plan to put aside Tuesday, March 8th for MSSNY’s Annual Physician Advocacy Day. To view the flyer, click here: MSSNY 2022 Lobby Day. To register, click here: Physician Advocacy Registration

The format will be similar to previous years, where assembled physicians and allies will hear from legislative leaders in the morning (via Zoom), and then have virtual visits with their respective legislators in the afternoon (coordinated by their county medical societies).

With COVID cases on the rise across NYS, we will be advocating for policies that encourage vaccination and support fair payment for telehealth care. We will also advocate for proposals that reduce prior authorization hassles. At the same time, we will voice our opposition to policies that would inappropriately expand the scope of practice for non-physicians and mandate how physicians provide care to their patients.

Please plan to join hundreds of colleagues from around the state on March 8th!


Garfunkel Banner Ad


New CPT Modifier 93: Audio-Only Services
At the September 2021 CPT Editorial Panel Meeting, a new Modifier was accepted to describe real-time telemedicine services between a patient and a physician or other qualified health care professional rendered via audio-only.  This new modifier is effective January 1, 2022.
Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System:
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

The official release information can be found on the AMA website.


AMA Updated Specialty Impact Analysis
The American Medical Association’s updated specialty impact analysis factors in the Protecting Medicare & American Farmers from Sequester Cuts Act, which avoided a 4% statutory cut from the PAYGO provisions, extended the moratorium on the 2% Medicare payment sequester, and mitigated the 3.75% Medicare physician payment cut. Note, the analysis is focused on the impact at the beginning of the year.


Premier Banner Ad


CMS Releases Updated CFs
CMS has now released the new 2022 PFS conversion factor of $34.6062 and Anesthesia CF of $21.5623. The updated CFs were included in newly updated spreadsheets on cms.gov.


Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302 


For the MSSNY 2021 Ad Rate Sheet, please click here.


Office Space for Lease – Great Neck, NY
Large, fully equipped space available for lease up to 7 days per week. Includes onsite parking and is close to mass transit. Call 516-972-2986 for info.


Rheumatology Practice Opportunity – Great Neck, NY
Opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join, share or merge practices. Fully equipped office with onsite parking and proximity to mass transit. Contact 516-972-2986 for more info.

 

 

 

 

 

 

 

 

 

MSSNY eNews: December 17, 2021 – Provider Relief Fund Reporting Open Until December 20

Wishing Each of You a Joyful Holiday Season and a Happy, Healthy 2022

Colleagues: 

As we come to the end of 2021 and look forward to 2022, I am filled with hope for the future. Despite huge challenges for physicians in the face of this historic pandemic, we have dug deep, persevered, and helped our patients navigate extraordinary challenges.  My hope is that 2022 will bring an end to this pandemic.

2021 has been a busy year for MSSNY. The improvements and changes underway give me a renewed sense of hope that our future—and the future of all organized medicine—is bright. We started the year by conducting a nationwide search for a new MSSNY EVP and were thrilled to hire Troy Oechsner, who hit the ground running. After extensive research, MSSNY is getting ready to implement a new database service to replace our present database dinosaur and is in the process of developing a plan for a complete overhaul of the MSSNY website. Troy hired Valerie Cammiso as our new VP of Membership and Heather Lopez as Director of Physician Payment and Practice. Troy, Valerie, and Heather each possess a sense of optimism and confidence—and all three have a wealth of experience in their respective fields that I’m confident will bring renewed value to MSSNY membership. They join an existing stellar MSSNY staff that continues to produce excellent work on behalf of all of us.

And our voice in Albany and Washington, DC remains strong. Here are just a few highlights of MSSNY’s work this year:

  • Rejected Physician Responsibility for 50% Excess Insurance Cost-Share
  • Protected Physician Due Process During OPMC Investigations
  • Protected Physician Confidentiality When a Complaint Has Been Filed Against Them With OPMC
  • MSSNY Advocacy resulted in the recent announcement that claims submitted to liquidated health insurer Health Republic would be paid
  • MSSNY worked with the NY Congressional Delegation, the American Medical Association (AMA) and the Federation of Medicine to prevent implementation of a 2% sequester cut until at least 2022 and to mostly prevent implementation of a 10% cut to Medicare physician payment conversion factor while continuing to move forward with payment increases to E&M codes.

As the year winds down, I wish each of you a joyful holiday season and a wonderful 2022 filled with good health and happiness.

Joseph Sellers, MD, FAAP
MSSNY President


Provider Relief Fund Reporting Period 1 Portal Open Until December 20 @ 12 PM
The Provider Relief Fund Reporting Period 1 portal will be reopened from 9:00 a.m. ET on December 13, 2021 through 11:59 p.m. ET on December 20, 2021. During this time, PRF recipients may register, request corrections, and/or submit their report on PRF payments received prior to June 30, 2020. This will be the final opportunity for providers to report on Reporting Period 1 payments.  Providers who submitted their reports before November 30, 2021 may request to have their report reopened for revisions by contacting the Provider Support Line (866-569-3522). All reports must be finalized and submitted before December 20, 2021 at 11:59 pm ET to be compliant with the terms and conditions of the PRF program.

To access the PRF reporting portal, please click here.
For additional information about PRF reporting, please visit the PRF webpage.


MLMIC Ad


Federal No Surprises Act Takes Effect in 15 Days: Are You Ready?
On January 1, 2022, a new and complex set of rules enacted by the federal government regarding “surprise bills” goes into effect. The statute is broad and sweeping and will have significant effects on any health care provider who renders services to out-of-network or uninsured patients. While many jurisdictions, including New York, New Jersey, Connecticut and Florida already have rules addressing surprise bills, the Federal law varies from the state laws in many ways, including having a far wider application.

The penalties for violating the Federal No Surprises Act law can be substantial. If you are uncertain about an aspect of the new law—whether you are covered, what aspects of your practice are covered, and how to comply—the GW Federal Surprise Bill Working Group can provide unmatched expert guidance.

Garfunkel Wild, P.C., a law firm dedicated to the health care industry, is pleased to announce the creation of a Federal Surprise Bill Working Group that has developed a particular level of expertise in addressing client questions about the new Federal No Surprises Act law.

Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.


DFS Develops Model Form for Physicians to Share with Patients Regarding Protections from Surprise Billing
The New York Department of Financial Services has finalized a New York-specific model form that physicians, hospitals and other health care providers will need to post on their website and in their practice location advising their insured patients of their legal protections against surprise medical bills.  The form developed by the DFS is a modified version of the template form developed by the US Department of Health and Human Services.  As noted in an upcoming DFS Circular letter, “Beginning January 1, 2022, each health care provider and facility must make publicly available, post on their public websites, and provide to insureds, a one-page notice in clear and understandable language containing information on:  the requirements and prohibitions of such provider or facility under 42 U.S.C. §§ 300gg-131 and 300gg-132 (relating to prohibitions on balance billing for emergency services and surprise bills); any other applicable state law requirements on such provider or facility prohibiting out-of-network balancing billing (including any state laws that provide consumer protections that go beyond the NSA); and information on contacting appropriate state and federal agencies in case an individual believes that such provider or facility has violated any state or federal prohibitions on balance billing for emergency services and surprise bills.

45 C.F.R. § 149.430(c) provides clarification regarding the methods for this disclosure.  When posting on the provider’s or facility’s website, the information or link to the information must appear on a searchable homepage of the provider’s or facility’s website.  If a provider or facility does not have a website, this requirement does not apply.  Additionally, for the information to be publicly available, the provider or facility must include the information on a sign posted prominently at the provider’s or facility’s location.  A sign is posted prominently if the sign is posted in a central location, such as where insureds schedule care, check in for appointments, or pay bills.  If the provider does not have a publicly accessible location, this requirement does not apply.  Lastly, the notice provided to the insured must be a one-page (double-sided) notice, using print no smaller than 12-point font.

The provider or facility must provide the notice in person or through postal mail, or if the insured consents, through electronic mail.”


Membership Renewal Banner


MSSNY Podcast: Omicron, Medicare and Surprise Bills
Listen to today’s MSSNY podcast as MSSNY Senior VP and Chief Legislative Counsel Moe Auster updates physician members on Omicron, Medicare, and Surprise Bills.


MSSNY in the News
WSYR LocalSyr.com (News 9) – 12/14/21
President of the Onondaga County Medical Society discusses the strain of COVID-19
(Interview with Dr. Robert Dracker,  President of the Onondaga County Medical Society)

PoliticsNY – 12/14/21
PoliticsNY Power Players in Health Care
(MSSNY President-Elect Parag Mehta named PoliticsNY Power Player)

CBS WRGB News 6 Albany  12/10/21
Capital Region hospitals not concerned over elective surgery postponements
(MSSNY President Dr. Joseph Sellers quoted) 

The Journal News (LoHud) – 12/06/21
Some NY counties lagging behind in COVID-19 vaccinations for ages 5 to 11. Here’s where
(MSSNY President Dr. Joseph Sellers quoted)

Also ran in:
Daily Messenger
Wayne Post
Genesee Country Express
Democrat and Chronicle
Observer-Dispatch
Times Telegram
Star-Gazette
Poughkeepsie Journal
The Steuben Courier Advocate
Irondequoit Post
The Evening Tribune
Wellsville Daily Reporter
Yahoo News
The Leader

Rochester First (WROC) – 12/03/21
Free rapid take-home tests and booster shots coming to Monroe County
MSSNY President Dr. Joseph Sellers Interviewed

The Hill – 11/29/21
Time to think beyond the vax? Reflections from a COVID-stricken doc
Op-ed by MSSNY Member, Dr. Frank Contacessa

LoHud.com – 11/22/21
As COVID surges, New York’s flu season is off to a troubling start. Will ‘twindemic’ hit?
(MSSNY President Dr. Joseph Sellers quoted)

Also ran in:
Daily Messenger
Democrat and Chronicle
Genesee Country Express
Star-Gazette
The Evening Tribune
The Leader
The Poughkeepsie Journal
The Steuben Courier Advocate
Times Telegram
Wayne Post
Wellsville Daily Reporter
Yahoo news           

InsuranceNewsNet – 11/21/21
Stakeholders Praise 4 House Members Letter to Admin Regarding Surprise Billing Interim Final Rule
(MSSNY President Dr. Joseph Sellers quoted)

Buffalo News – 11/12/21
Covid cases are rising in younger people. So are urgent calls to get them vaccinated
(Former MSSNY President Dr. Thomas Madejski quoted)

Harlem World Magazine – 11/03/21
Attorney General James Defends New York State’s Gun Licensing Protection Law At Supreme Court
(MSSNY President Dr. Joseph Sellers quoted)

Crain’s Health Pulse – 11/3/21
Labor costs driving up expenses for hospitals, physician practices
MSSNY Past Presidents Dr. Thomas Madejski and Dr. Charles Rothberg interviewed)


Sellers Banner Ad


Podcast on Omicron and Antivirals with MSSNY Infectious Diseases Committee Chair Dr. William Valenti Available Now
Questions about the Omicron COVID Variant and the newly developed antivirals for COVID-19?  Listen to MSSNY’s latest podcast on Omicron and antivirals here.  Chair of MSSNY Infectious Diseases Committee, Dr. William Valenti offers insight on the latest COVID variant, Omicron, and provides information on the newly developed COVID antivirals.  Also be sure to check out all MSSNY’s other podcasts on topics ranging from Emergency Preparedness to Veterans Matters to Legislative Updates.  And go to https://cme.mssny.org  to explore all of MSSNY’s CME programs.


COVID-19 Exacerbating Physician Stress: MSSNY is Here to Help
Stress and burnout among physicians have been well documented for years. The COVID-19 pandemic is exacerbating the public health problem of physician burnout in New York state. Throughout the pandemic, physicians and other health professionals have faced concerns about safety, overworking, and feelings of loss.

MSSNY understands that with the Holiday season, comes a great deal of stress for many.

If someone you know is struggling with life stressors, encourage them to reach out to the P2P program to connect them to a peer supporter!

Email: P2P@mssny.org or call 1-844-P2P-PEER (1-844-727-7337) to request to be connected with a peer supporter.

Without an intervention, it is possible that a high number of physicians over the next few years may develop chronic stress reactions, anger, clinical depression, substance abuse, post-traumatic stress disorder, and suicidality.

If you wish to become a trained peer supporter, please reach out to Cayla Lauder, MPH, Program Coordinator, at clauder@mssny.org.


CPH Banner


MSSNY Calls on Governor Hochul to Sign Bill to Increase PBM Transparency & Limit Insurers’ Mid-Year Formulary Changes: Members Urged to Take Grassroots Action
Physicians are again urged to send a letter asking Governor Hochul to sign two bills into law that are critical to helping patients access the medications they need and to ensuring greater oversight of pharmacy benefit formulary development practices.  Physicians can send a letter or tweet from here.

The first piece of legislation, (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of Pharmacy Benefit Managers (PBMs). The bill was amended from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in Governor Cuomo’s veto message two years ago.

The bill requires that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. It also calls for disclosure of all possible revenue streams, terms, and conditions, that they place on their networks of pharmacies. MSSNY has supported greater oversight and regulation of PBMs as one manner to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications.

The second bill, A.4668, People-Stokes/S.4111, Breslin, would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. The bill was revised from the version that passed both chambers two years ago, but was vetoed by then Governor Cuomo. To address concerns raised in his veto message, the legislation now prohibits the applicability of a mid-year formulary change to a patient who was on the medication at the beginning of the policy year, or suffers from a condition for which the medication is part of a treatment regimen, for that condition. However, other mid-year formulary changes could still occur.

Physicians can send a letter to ask Governor Hochul to sign both bills here.


MSSNY Tip of the Week: Time-Based Billing for E/M Guide
Effective January 1, 2021, the new time-based billing for E/M codes went into effect and should be used now. This will allow you to bill a higher-level CPT code in the event certain time metrics are met. To ensure you are receiving the most appropriate reimbursement for your time, please take a moment to review this document.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice Heather Lopez at 518.465.8085 X332 | hlopez@mssny.org.


Garfunkel Banner Ad


The Telehealth Initiative
As part of the Telehealth Initiative project, MSSNY and the AMA will work together to develop relevant educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation. MSSNY will be part of a national network to establish and maintain strong relationships with physicians, practices, and health systems interested in implementing, optimizing, or sustaining telehealth. In addition to providing ongoing support, this year’s program will emphasize the importance of realizing the true value of virtual care. MSSNY has secured four signed statements of interest: C DOC, Mount Sinai, Northwell TeleICU/Telehealth, and Eger Healthcare and Rehabilitation Center.

MSSNY is hoping to have close to 10 practice sites in total. As a collaborating partner, team leaders will participate in a “kick-off” meeting with leaders from practice sites in New York and in other states. Each practice site will be involved in dissemination of a telehealth survey assessing practice/physician experience using telehealth. In addition to participation in the Telehealth Survey, the project team will collect baseline, mid- point, and final data points to measure the impact of telehealth in their practices using the Return on Health framework. Access to educational resources from the AMA and expert mentoring to discuss optimization and sustaining telehealth into practice, virtual events and discussions which provides a network for physicians and care teams to share experiences will be provided to all participants.

If you or someone you know is interested in joining this initiative, please reach out to Cayla Lauder, MPH, Program Coordinator at clauder@mssny.org.


Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
With just a few weeks left in the year, physicians are again urged to contact Governor Hochul’s office to encourage her to veto multiple problematic pro-trial lawyer bills that if signed could have the effect of significantly disadvantaging defendants generally in litigation in New York State, including physicians and hospitals defending against malpractice claims.

While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts.  These bills include:

  • A8041/S7052 (“The Comprehensive Insurance Disclosure Act”) – Imposes excessive insurance disclosure requirements on defendants during litigation, which has been strongly opposed by many groups. Business groups urge Hochul to veto insurance bill (nystateofpolitics.com)
  • A2199/S473 – Expands the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
  • A8040/S7093 – Changes a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.

Classified Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302


For the MSSNY 2021 Ad Rate Sheet, please click here.


Office Space for Lease – Great Neck, NY
Large, fully equipped space available for lease up to 7 days per week. Includes onsite parking and is close to mass transit. Call 516-972-2986 for info.


Rheumatology Practice Opportunity – Great Neck, NY
Opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join, share or merge practices. Fully equipped office with onsite parking and proximity to mass transit. Contact 516-972-2986 for more info.

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY Thanks Richard Gottfried for his Many Years of Service and Wishes him Well in Retirement

For Immediate Release
December 14, 2021

 

MSSNY Thanks Richard Gottfried for his Many Years of Service
and Wishes him Well in Retirement
 

Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York 
 

“Richard Gottfried’s retirement from the Assembly after 52 years of service marks the end of an era.  As the author of countless laws to expand insurance coverage for patients and to address various public health threats, Assemblymember Gottfried has long been a champion for protecting patients’ ability to receive timely and quality health care. Chair Gottfried could be counted on to thoughtfully discuss and consider questions raised by physicians and others regarding how best to achieve our shared goals, even on occasion when we had to agree to disagree on the merits of a particular proposal.

“Chair Gottfried has been a consistent champion in efforts to expand affordable health insurance coverage availability and to protect the patient-physician treatment relationship from corporate interference from health insurers and Pharmacy Benefit Managers (PBMs). This was demonstrated through his advancement of legislation to provide state regulation of PBMs, to reduce excessive health insurer-imposed prior authorization burdens, to eliminate onerous contract provisions that adversely impact patient access to care, and to permit collective bargaining rights to community-based health care providers.

“The State Capitol will certainly be a different place without Assemblyman Gottfried‘s regular presence.  We thank him for his decades of service to the public and wish him a happy retirement.”

# # #

Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.
 

Media Contact:
Roseann Raia | Communications / Marketing
Medical Society of the State of New York
865 Merrick Avenue
Westbury, NY 11590
516.488.6100 x302 | rraia@mssny.org

MSSNY Calls SCOTUS Ruling on Vaccination Requirement for Health Care Workers “An Important Win for Our Collective Public Health”

For Immediate Release 
December 14, 2021

 

MSSNY Calls SCOTUS Ruling on Vaccination Requirement for Health Care Workers “An Important Win for Our Collective Public Health”

 

Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York 

“The Medical Society of the State of New York has strongly supported the requirement for all health care workers to be vaccinated against COVID-19.  It is an important win for our collective public health that the U.S. Supreme Court has denied a request to block New York’s vaccination mandate for health care workers that does not include an exception for religious objectors.

“We are confident that the Supreme Court ruling signifies another step toward bringing this pandemic to an end. We once again encourage every eligible New Yorker to roll up their sleeves and get vaccinated and boosted against COVID-19.”

# # #

Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.  

Media Contact:
Roseann Raia | Communications / Marketing
Medical Society of the State of New York
865 Merrick Avenue
Westbury, NY 11590

516.488.6100 x302 | rraia@mssny.org

MSSNY eNews: December 15, 2021 – Provider Relief Fund Phase 4 Payments Going Out This Week

.

Provider Relief Fund Phase 4 Payments Going Out This Week
Yesterday, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the distribution of approximately $9 billion in Provider Relief Fund (PRF) Phase 4 payments to health care providers who have experienced revenue losses and expenses related to the COVID-19 pandemic.  This includes nearly 5,000 providers in New York State totaling over $750 million.

The average payment announced yesterday for small providers is $58,000, for medium providers is $289,000, and for large providers is $1.7 million. More than 69,000 providers in all 50 states, Washington, D.C., and eight territories will receive Phase 4 payments. Payments will start to be made later this week.

The PRF Phase 4 payments, in addition to the $8.5 billion in American Rescue Plan (ARP) Rural payments to providers and suppliers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries, are part of the $25.5 billion the Biden-Harris Administration is releasing to health care providers to recruit and retain staff, purchase masks and other supplies, modernize facilities, or other activities needed to respond to COVID-19. The AMA has advocated for more of the PRF to be distributed, particularly those providers who serve in rural areas and who see low-income patients. In response, HHS is reimbursing smaller practices at a higher percentage of their revenue losses and expenses due to COVID-19, as well as using Medicare reimbursement rates to calculate payments for practices that care for Medicare, Medicaid, and CHIP patients.

It is important to keep in mind that funds received over $10,000 in the aggregate during a PRF reporting period will trigger a reporting requirement through the Provider Relief Fund Reporting Portal. Additional information on PRF reporting and auditing may be found here.

For more information on the PRF Phase 4 monies, please the materials below:


Various Lawsuits Underway to Challenge Faulty HHS IDR Rules; Most Other Provisions of the No Surprises Act to Go Forward January 1
As reported last week, the AMA and the American Hospital Association (AHA) have filed a lawsuit in the DC Federal Court against several federal agencies challenging these agencies’ misguided implementation of the federal No Surprises Act (NSA).  This follows a lawsuit filed by the Texas Medical Association (TMA) last month in a Texas Federal Court against various federal agencies challenging a narrow but critical provision of a rule issued on Sept. 30 by these agencies.

Both lawsuits allege that the federal regulators’ interpretation upend the careful compromise Congress set forth for resolving billing disputes.  Specifically, the federal regulation directs arbiters under independent dispute resolution (IDR) to presume that the health insurer’s self-determined median in-network rate is the appropriate out-of-network rate, and limiting when and how other factors come into play. The TMA and AMA lawsuits argue that the regulations are an improper deviation of the law as written by Congress which detailed a series of factors to be considered in the IDR without any one factor being the dominant consideration over the others.

With the TMA filing a motion for summary judgement last Friday, the Physicians’ Advocacy Institute (PAI) will be filing an amicus brief to support this action on behalf of itself and 10 other state medical societies including MSSNY.  It is likely that many specialty and state medical associations will file an amicus in the AMA/AHA action as well.

New York State to Issue Guidance on Implementation of NSA in New York

Physicians are once again reminded that the lawsuit on one aspect of the NSA will not prevent the law’s core patient protections from being required to be followed on January 1, 2022. MSSNY has written several newsletter articles regarding other key provisions of the NSA law that physicians should be sure they are following: MSSNY eNews: November 19, 2021 – 10 Key Provisions of No Surprises Act Implementation in NY

A New York State Department of Financial Services (DFS) Circular Letter will be issued shortly that seeks to provide clarification of several components of New York’s law that may be inconsistent with the NSA, such as provisions that would:

  • Ensure that that the provisions of New York’s surprise bill law will apply to all out of network providers, not just hospitals and physicians;
  • Clarify that the “visit” subject to patient protection under New York’s surprise bill law includes: equipment and devices, telemedicine services, imaging services, laboratory services, preoperative and postoperative services, and other such services as HHS may specify;
  • Clarify that New York’s surprise bill law applies to all safety net hospitals;
  • Clarify that previously exempted CPT codes 99281 – 99285, 99288, 99291 – 99292, 99217 – 99220, 99224 – 99226, and 99234 – 99236 are no longer exempted from NY’s surprise bill law;
  • Clarify that the insured’s cost-sharing will be calculated based upon the health insurer’s initial payment amount to the physician, hospital or other care provider
  • Clarify that patients cannot be asked to waive protections for both emergency and surprise out of network bills
  • Clarify that, even if a patient does not sign an assignment of benefits form, upon receipt of a claim from a provider for a surprise bill or for emergency services, an issuer must send the initial payment or notice of denial of the payment directly to the provider
  • Remind health care providers of the federal NSA requirement to post on their website and in their practice location a model form that sets forth patient protections against balance billing

There are also likely to be DFS Circular Letters regarding addressing NSA rules related to continuity of care for patients after a provider leaves a network, and consequences of provider directory misinformation, that will be issued soon as well.


MLMIC Ad


Health Department Update on COVID-19 for New York: Oral Antiviral Treatment, General Updates, and Co-Circulation with Influenza
Join the NYS and NYC Health Departments for a COVID-19 informational webinar tomorrow, Thursday, December 16, 2021, from 1-2 p.m.

To access the webinar visit YouTube Live on December 16 at 1 pm.
Audio number: 844-512-2950. Click here to view the flyer with additional details and to share with interested colleagues. There are no capacity limits, and no registration is required.


MSSNY Calls SCOTUS Ruling on Vaccination Requirement for Health Care Workers “An Important Win for Our Collective Public Health”
Fierce Healthcare (12/14, Landi) reports the Supreme Court on Monday rejected “a challenge to New York’s requirement that health care workers be vaccinated against COVID-19 even when they cite religious objections,” a decision applauded by the Medical Society of the State of New York. The organization called the move an “important win” for public health. MSSNY President Joseph Sellers, MD, said, “We are confident that the Supreme Court ruling signifies another step toward bringing this pandemic to an end. We once again encourage every eligible New Yorker to roll up their sleeves and get vaccinated and boosted against COVID-19.”

MSSNY’s Press Statement


Insurance Banner Ad


Picture of Dr. MehtaCongrats to #MSSNY President Elect @ParagMehta6 on being named one of @PoliticsNYnews Power Players in Healthcare https://t.co/siiWHPE10O pic.twitter.com/xTk90V5hnO

— Medical Society NY (@mssnytweet) December 15, 2021


Mark Your Calendars: MSSNY’s Virtual Lobby Day is on March 8th
Please plan to put aside Tuesday, March 8th for MSSNY’s Annual Physician Advocacy Day. To view the flyer, click here: MSSNY 2022 Lobby Day. To register, click here: Physician Advocacy Registration

The format will be similar to previous years, where assembled physicians and allies will hear from legislative leaders in the morning (via Zoom), and then have virtual visits with their respective legislators in the afternoon (coordinated by their county medical societies).

With COVID cases on the rise across NYS, we will be advocating for policies that encourage vaccination and support fair payment for telehealth care. We will also advocate for proposals that reduce prior authorization hassles. At the same time, we will voice our opposition to policies that would inappropriately expand the scope of practice for non-physicians and mandate how physicians provide care to their patients.

Please plan to join hundreds of colleagues from around the state on March 8th!


Legislation Introduced to Extend and Expand Provide Contract with All Health Care Providers
Legislation (A.8511/Dinowitz, D-Bronx) was introduced this week that would extend contracts between health plans and health care providers that are unilaterally terminated or not renewed, for 120 days from the date of the termination or non-renewal. This will enable patients to continue to see their provider under the terms of the former contract, providing for continuity of care.

Current law requires a 60-day “cooling off” period when either a hospital or health insurer terminates or non-renews a contract with the other.  This bill would not only extend this period of time to 120 days, it would also apply to all healthcare providers who have a contract with a health insurer.  As noted in the sponsor’s memo in support, the bill would provide for coverage during the 120-day period for entities that are part of the provider’s organization included in their previous contract, not just hospitals as is currently the law.

MSSNY is analyzing this legislation. On the one hand, many physicians have brought concerns to MSSNY about being unfairly dropped from health insurer networks without a legal way to challenge this non-renewal.  On the other hand, it could require continued participation in what may be an unfair contract. The sponsor’s memo of support further notes that “When a massive health insurance company and a health care provider organization cannot come to an agreement on rates, New Yorkers who happen to have such insurance should be given ample time to plan for the change in their health care access. This is especially true in areas where one provider dominates a region’s health care market.  Such was nearly the case in the Bronx where United healthcare (UHC) and Montefiore failed to renew their contract for over seven months, placing thousands in jeopardy of losing access to their primary care doctors and health care services provided by Montefiore.


Garfunkel Banner Ad


New York Department of Financial Services (DFS) Secures $3.1 Million For New Yorkers Using Mental Health & Substance Use Disorder Parity Compliance Review
Acting New York State Department of Financial Services (DFS) Superintendent, Adrienne A. Harris, announced yesterday that it had secured $3.1 million following a review of whether New York insurers were in compliance with state and federal cost-sharing requirements for mental health and substance use treatment.

DFS reviewed mental health and substance use disorder parity reports that insurers must submit every two years to gauge if insurers were providing the same level of mental health and substance abuse disorder benefits that they do for medical care. The review found that Aetna, Oscar, and Wellfleet sold policies that required consumers to pay a copayment or coinsurance for mental health and substance use disorder benefits that was not permitted under the law.

The three insurers have agreed to DFS’ findings and signed consent orders. The violations, monetary penalties, and consumer restitution amounts include:

  • Aetna Life Insurance Company was fined $874,000 for violation of MHPAEA and New York Insurance Law, $376,000 for erroneous data reporting, and will return $439.20 to consumers;
  • Oscar Insurance Corporation was fined $1,000,000 for violation of MHPAEA and New York Insurance Law and will return $465,800 to consumers; and
  • Wellfleet New York Insurance Company was fined $425,000 for violation of MHPAEA and New York Insurance Law and will return $7,326.70 to consumers. 

MSSNY worked together with the New York State Psychiatric Association (NYSPA) and other mental health care advocates in 2019 to help enact legislation to establish the parity compliance report requirements. 

The overall DFS monetary penalty is $2,675,000, of which $2,299,000 will go to the Behavioral Health Parity Compliance Fund to provide funding for initiatives that support parity implementation and enforcement, including DFS’ Behavioral Health Ombudsman Program. The remainder of the funds will go to the state’s General Fund. The total amount being returned to consumers is $473,565.90.

Click here to access a copy of the consent orders.  


Judge Orders NYC to Delay Implementation of Retiree Health Care Switch to Medicare Advantage Until April 1st: Opt-Out Period Extended To June 30th
Following negotiations this past summer between municipal unions, and the city of New York, an agreement was reached to transition New York City retirees from their current, traditional Medicare plan to Medicare Advantage (MA) plans. Beneficiaries will have the ability to opt-out of the NYC Medicare Advantage Plus Plan and remain enrolled in their current, traditional Medicare plan. The new plan is being administered by Emblem and Empire Blue Cross/Blue Shield and coverage for these enrollees is now scheduled to begin on April 1, 2022 and retirees have until June 30th
to opt-out of the program all together.

As reported in NY Focus (Judge Orders City to Delay Retiree Health Care Switch Until April 1),  in a three-page order issued on Tuesday, the judge overseeing the case laid out a series of conditions that the city must comply with before implementing the new Medicare Advantage plan. He specified that retirees must be allowed to opt-out of the plan until at least June 30, 2022—three months after the plan is scheduled to go into effect. In addition, the City must take steps to ensure that retirees are fully informed about what treatments and procedures are included in the new plan, and which doctors will and will not be participating. Confusion among retirees about what services will be included in the plan has been widespread, especially after the city mailed them a guide to the plan that contained numerous errors–and then refused to send a follow up correction.

The City must also send retirees a letter correcting the errors in its initial plan by January 7, 2022 and the letter must contain information on how retirees can obtain a corrected Enrollment Guide, free of charge, and list the specific websites with the corrected Enrollment Plan. Moreover, starting January 7, 2022, until the plan becomes active on April 1st, the city must submit biweekly reports detailing its efforts to contact providers to inform them about the plan, and a schedule for how and when it will contact additional providers. The Organization of Public Service Retirees’ underlying case seeking to stop the move outright is still under consideration and will be decided when the preliminary injunction has been lifted.

Many MSSNY members have raised concerns about possible adverse impacts on patients once their new MA coverage becomes effective. To that end, several MSSNY physician leaders met virtually on October 21st with representatives from Empire Blue Cross Blue Shield to discuss questions from physicians regarding the possible impact of the upcoming transition for patient care delivery.  The issue was also discussed extensively at the November 4 MSSNY Council meeting. Moreover, Kings County Medical Society Past-President, Dr. Donald Moore, testified regarding the potential new prior authorization requirements at a hearing about the issue, that was held on Thursday, October 28th by the New York City Council Committee on Civil Service and Labor.

MSSNY will continue to work with affected physicians and their patients to monitor the materials developed for retirees and physicians regarding this transition to ensure they are accurate. Empire and Emblem have also developed educational materials for physicians and other providers including webinars. MSSNY will monitor the impact of the new plans if or when they’re implemented for reports of potential pre-authorization and claims hassles for physicians, and barriers to care for patients.

To view materials provided to MSSNY by Emblem and Empire Blue Cross/Blue Shield:

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:a0c9b2b3-7ab2-4541-a03c-039ab65a2e57

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:91d24327-df43-402d-8d73-5a75b2a20783

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:9a0b7f28-5814-4c0f-9821-8f5efe8f9e55

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:c49e3c1a-7984-4c10-8fe0-d410074dd953

To access a range of other information shared by the NYC Office of Labor Relations:

https://www1.nyc.gov/site/olr/health/retiree/health-retiree-responsibilities-assistance.page


ClearClix Banner Ad


Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302 


For the MSSNY 2021 Ad Rate Sheet, please click here.


Office Space for Lease – Great Neck, NY
Large, fully equipped space available for lease up to 7 days per week. Includes onsite parking and is close to mass transit. Call 516-972-2986 for info.


Rheumatology Practice Opportunity – Great Neck, NY
Opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join, share or merge practices. Fully equipped office with onsite parking and proximity to mass transit. Contact 516-972-2986 for more info.

 

 

 

 

 

 

 

 

 

MSSNY eNews: December 10, 2021 – Medicare Cuts Halted

Medicare Cuts Halted

Colleagues:

Events this week underscored the importance of grassroots physician advocacy. Thanks to sustained advocacy on the part of our MSSNY physicians and our colleagues around the country, we received good news. On Tuesday evening, by a 222-212 vote, the US House of Representatives passed the Protecting Medicare & American Farmers from Sequester Cuts Act to hold off most of the cumulative 10% Medicare cuts to physician payment that were scheduled to go into effect January 1, 2022.

And late last night we received more good news when the US Senate passed the legislation to halt the Medicare physician payment cuts. President Biden is expected to sign the bill into law. (See the fourth article below for more detailed information on the legislation).

This is an example of what can be accomplished when we pull together and present a united front to our legislators. The physicians of New York, and around the country, spoke—and Congress listened. We are grateful to the many members of the New York Congressional delegation who recently joined a letter to Speaker Pelosi and Leader McCarthy urging action to prevent these cuts. And we thank the many of you who contacted your local US Representative and Senators Schumer and Gillibrand highlighting just how devastating and ill-timed this cut could have been.

United we stand, divided we fall. While we have so many more areas where we need our legislators to act to help protect our patients’ access to care, this is an example of how we can accomplish great things when we work together.

Joseph Sellers, MD, FAAP, FACP
MSSNY President


MLMIC Ad


Governor Announces Indoor Mask Requirement for Businesses
Governor Kathy Hochul today announced that masks will be required to be worn in all indoor public places effective Monday, December 13, unless businesses or venues implement a vaccine requirement.

The press release announcing the requirement noted that, since Thanksgiving, the statewide 7-day average case rate has increased by 43% and hospitalizations have increased by 29%.  The press release further noted that “While the percentage of New Yorkers fully vaccinated continues to increase—gaining 2% from Thanksgiving weekend to now—the uptick is not fast enough to completely curb the spread of the virus, particularly among communities with low vaccination coverage.”

“I have warned for weeks that additional steps could be necessary, and now we are at that point based upon three metrics: Increasing cases, reduced hospital capacity, and insufficient vaccination rates in certain areas,” Governor Hochul added.

The press release noted that businesses and venues who implement a proof of vaccination requirement can accept Excelsior Pass, Excelsior Pass Plus, SMART Health Cards issued outside of New York State, or a CDC Vaccination Card. In accordance with CDC’s definition of fully vaccinated, full-course vaccination is defined as 14 days past an individual’s last vaccination dose in their initial vaccine series (14 days past the second shot of a two-dose Pfizer-BioNTech or Moderna vaccine; 14 days past the one-shot Janssen/Johnson & Johnson vaccine).

The press release further noted that businesses and venues that implement a mask requirement must ensure all patrons two years and older wear a mask at all times while indoors.


MSSNY President Talks to CBS/Albany About Elective Surgery Postponements: The solution is not unreasonable, but I don’t know if it’s enough”
In an interview with CBS/Albany last evening for a piece on elective surgery postponements in Capital Region hospitals, MSSNY President Dr. Joseph Sellers said  “The solution is not unreasonable, but I don’t know if it’s enough. They seem to have learned some lessons from the prior administration when things were done in a very centrally controlled manner,” said Dr. Joseph Sellers, Medical Society of New York President. “There is more leeway for physicians to attest that a patient would suffer if something was postponed. We have ways to assess the risks and benefits of going ahead with surgeries. So, it’s not a full ban, and that’s good. I think people will get the care they need.” Link to CBS6Albany video.


 

Membership Renewal Banner


AMA, AHA File Lawsuit to Challenge Faulty HHS Rules Implementing Surprise Billing Law
The American Hospital Association (AHA) and American Medical Association (AMA) filed a lawsuit Thursday against several federal agencies challenging these agencies’ misguided implementation of the federal No Surprises Act (NSA).

The lawsuit challenges a narrow but critical provision of a rule issued on Sept. 30 by the U.S. Department of Health and Human Services (HHS) and other agencies. The provision being challenged ignores requirements specified in the NSA which could significantly adversely narrow care options for patients in hospitals across the country.   The rule and this flawed provision are set to take effect on January 1.

The AHA and AMA noted in an accompanying press release that “they strongly support protecting patients from unanticipated medical bills and were instrumental in passing the landmark No Surprises Act to protect patients from billing disputes between providers and commercial health insurers.”

However, the legal challenge is necessary because the federal regulators’ interpretation upends the careful compromise Congress deliberately chose for resolving billing disputes. As noted in the AMA/AHA press release “the new rule places a heavy thumb on the scale of an independent dispute resolution process, unfairly benefiting commercial health insurance companies. The skewed process will ultimately reduce access to care by discouraging meaningful contracting negotiations, reducing provider networks, and encouraging unsustainable compensation for teaching hospitals, physician practices, and other providers that significantly benefit patients and communities.”

Specifically, the federal regulation directs arbiters under independent dispute resolution (IDR) to presume that the health insurer’s self-determined median in-network rate is the appropriate out-of-network rate and limiting when and how other factors come into play. The lawsuit argues that the regulations are an improper deviation of the law as written by Congress which set forth a series of factors to be considered in the IDR without any one factor being the dominant consideration over the others.

Physicians should be aware that the lawsuit will not prevent the law’s core patient protections from moving forward on January 1, 2022. MSSNY has written several newsletter articles regarding other key provisions of the law that physicians should be sure they are following: MSSNY eNews: November 19, 2021 – 10 Key Provisions of No Surprises Act Implementation in NY –

Last month, the Texas Medical Association filed a lawsuit in a Texas federal court making similar legal challenges against HHS’ interpretation of the NSA. The Physicians’ Advocacy Institute is likely to file an amicus brief to support this action on behalf of itself and 10 other state medical societies including MSSNY.

Moreover, last month, a bipartisan group of 152 lawmakers urged the Administration to fix the independent dispute resolution provisions, noting the rule’s approach “is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law.”

For additional information, please see copies of the filed complaint and motion to stay by the AMA and AHA.  Please remain alert for further updates.


Senate Passes Legislation to Prevent Medicare Cuts; President Expected to Sign
Last night, the US Senate passed legislation to halt most of the cumulative 10% Medicare physician payment cuts that had been scheduled to take effect on January 1, after the US House had passed the legislation earlier this week. President Biden is expected to sign the bill into law.  Specifically, the legislation would:

  • Delay the resumption of the 2% Medicare sequester for three months (January 1- March 31, 2022). The legislation then provides for a 1% sequester for the following three months (April 1-June 30, 2022), with the full sequester to be re-implemented on July 1, 2022.
  • Provide for a one-year increase in the Medicare Physician Fee Schedule of 3% (0.75% less than the conversion factor boost provided for 2021).
  • Eliminate through 2022 the scheduled 4% Medicare PAY-GO cut
  • A one-year delay in the cuts to the clinical lab fee schedule.
  • A one-year delay in the Medicare radiation oncology demonstration.

“The wheels of Congress don’t always move quickly, but today they did move toward preserving the viability of physician practices and maintaining access to care,” stated AMA President Dr. Gerald Harmon. “Potential reductions in Medicare payments for physician services hung over the heads of patients and practices like a sword of Damocles. The Senate action today, following a similar House vote this week, would delay the reductions and give Congress time to work on reforms to address the flaws in the Medicare payment system.

Earlier this week, MSSNY President Dr. Joseph Sellers issued a statement thanking the many members of the New York Congressional delegation who recently joined a letter to Speaker Pelosi and Leader McCarthy urging action to prevent these cuts, but noted that “we are nearly out of time” and urged “immediate action to help ensure that community-based physicians will still be able to provide the health care services that are expected and deserved by our patients.”

Certainly, the time-limited nature of these actions will necessitate more AMA, MSSNY and grassroots physician advocacy in 2022 to prevent further Medicare cuts.


Garfunkel Banner Ad


MSSNY Calls on Governor Hochul to Sign Bill to Increase PBM Transparency & Limit Insurers’ Mid-Year Formulary Changes: Members Urged to Take Grassroots Action
Physicians are again urged to send a letter asking Governor Hochul to sign two bills into law that are critical to helping patients access the medications they need and to ensuring greater oversight of pharmacy benefit formulary development practices. The deadline to sign or veto both bills is the end of December.  Physicians can send a letter or tweet from here: Urge Governor to SIGN two RX bills – Regulating PBMs and Restricting Mid-Year Formulary Changes (p2a.co)

The first piece of legislation, (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of Pharmacy Benefit Managers (PBMs). The bill was amended from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in Governor Cuomo’s veto message two years ago.

The bill requires that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. It also calls for disclosure of all possible revenue streams, terms, and conditions, that they place on their networks of pharmacies. MSSNY has supported greater oversight and regulation of PBMs as one manner to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications.

The second bill, A.4668, People-Stokes/S.4111, Breslin, would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. The bill was revised from the version that passed both chambers two years ago, but was vetoed by then Governor Cuomo. To address concerns raised in his veto message, the legislation now prohibits the applicability of a mid-year formulary change to a patient who was on the medication at the beginning of the policy year, or suffers from a condition for which the medication is part of a treatment regimen, for that condition. However, other mid-year formulary changes could still occur.

Physicians can send a letter to ask Governor Hochul to sign both bills here: Urge Governor to SIGN two RX bills – Regulating PBMs and Restricting Mid-Year Formulary Changes (p2a.co)


PHHPC Approves Three Regulations to be Adopted by NYS DOH
The New York Public Health and Health Planning Council (PHHPC) met on Thursday December 9. During their meeting, the Council approved the following three regulations to be adopted by the New York State Department of Health:

  1. This regulation conforms existing DOH regulations relative to abortion services with the provisions of the Reproductive Health Act (S240) enacted two years ago by the state legislature, and it permits the clinical examination prior to the procedure to be performed through telemedicine.
  2. This regulation allows the Department of Health to extend the deadline by which all hospitals designated as “stroke centers” must initiate a certification process with a certifying organization approved by the Department.
  3. This regulation updates tables and corrects topographical/technical errors in NYS law. It allows the Department of Health to maintain full primacy for delivery, oversight, and management of NY’s public drinking water supply, and it ensures consistency with EPA regulations.


Sellers Banner Ad


CDC Strengthens Booster Recommendations for 16- and 17-Year Olds
On December 9, the CDC strengthened its booster recommendations to indicate that everyone 16 and older receive a booster shot of the Pfizer-BioNTech COVID-19 vaccine six months after their primary series. This follows the CDC’s November 29 recommendation for booster doses for anyone 18 years or older either 6 months after their primary vaccine series of Pfizer-BioNTech or Moderna, or 2 months after their primary vaccine series of Janssen/Johnson & Johnson. At this time, only the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended for adolescents aged 16 and 17.

For more information, click on the following links:

Guidance for The New York State COVID-19 Vaccination Program

Information for Health Care Professionals about the Screening Checklist for the COVID-19 Vaccine

Individuals 12 Years of Age or Older, and the COVID-19 Immunization Screening and Consent Form.


SUNY Upstate Medical University Physician Survey on Vaccine Knowledge, Attitudes and Practices
The COVID-19 pandemic has caused a dramatic decline in vaccine uptake. As more people remain un- or under-vaccinated, communities are increasingly susceptible to outbreaks of vaccine-preventable diseases. In an effort to combat this reduction in vaccinations, SUNY Upstate Medical University is conducting a survey study among healthcare professionals across the state to assess vaccine knowledge, attitudes, and practices. Your answers can help to impact changes in the community as these data will guide under-vaccination from a provider focus. After study closure, up to 5 members from MSSNY who have completed the survey will be randomly selected to win a free copy of the Committee on Infectious Disease, American Academy of Pediatrics Red Book – an important resource on pediatric infectious diseases and vaccinations.

Please consider completing this survey on vaccine knowledge, attitudes, and practices, which should take no more than 10 minutes.  Questions about the survey? Contact SuryadeM@upstate.edu.


 

Premier Banner Ad


Classified Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302


For the MSSNY 2021 Ad Rate Sheet, please click here.


Office Space for Lease – Great Neck, NY
Large, fully equipped space available for lease up to 7 days per week. Includes onsite parking and is close to mass transit. Call 516-972-2986 for info.


Rheumatology Practice Opportunity – Great Neck, NY
Opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join, share or merge practices. Fully equipped office with onsite parking and proximity to mass transit. Contact 516-972-2986 for more info.

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: December 8, 2021 – House Passes Bill to Prevent Medicare Cuts

.

House Passes Bill to Prevent Staggering Medicare Cuts Following Sustained Physician Advocacy
On Tuesday night, by a 222-212 vote, the US House of Representatives passed the Protecting Medicare & American Farmers from Sequester Cuts Act which would temporarily hold off most of the cumulative 10% Medicare cuts to physician payment that are scheduled to go into effect January 1, 2022. The bill is expected to be passed by the Senate as well as part of a larger package to raise the debt ceiling.

Specifically, the bill would extend a moratorium on a 2% sequester cut through March 31, 2022 that had been scheduled to expire at year end 2021. It also would delay a 4% budget-balancing cut known as PAYGO until 2023. Finally, it would provide a one-year, 3% increase in the Medicare physician fee schedule, to offset the 3.75% conversion factor cut contained in the 2022 Medicare payment rule.

Gerald E. Harmon, M.D., president of the American Medical Association, praised Congress for “taking a decisive step” and urged Congress to “support this bipartisan proposal and join together again in the new year to develop long-term solutions to address the flaws in the Medicare payment system.”

On Tuesday, MSSNY President Dr. Joseph Sellers issued a statement thanking the many members of the New York Congressional delegation who recently joined a letter to Speaker Pelosi and Leader McCarthy urging action to prevent these cuts, but noted that “we are nearly out of time” and urged “immediate action to help ensure that community-based physicians will still be able to provide the health care services that are expected and deserved by our patients.”

Until this is finalized, physicians can send a letter to Senators Schumer and Gillibrand urging action to prevent steep Medicare cuts here: Be Heard | Physicians Grassroots Network.


Update on Litigation Related to the IDR Portion of the No Surprises Act and Implementation of Other NSA Requirements
The Physicians Advocacy Institute (PAI) will be filing an amicus brief on behalf of itself as well as MSSNY and the other 9 affiliated state medical associations to support the lawsuit filed by the Texas Medical Association (TMA) against several federal agencies challenging its erroneous implementation of the federal No Surprises Act (NSA).

As has been reported in MSSNY e-news, the TMA lawsuit alleges that, in enacting the Interim Final Rule (IFR) on the NSA, federal agencies: (1) improperly failed to follow direction from Congress about how to implement the Independent Dispute Resolution (IDR) process set forth in the NSA by giving undue weight to the health insurer’s self-determined qualifying payment amount as part of the IDR determination and (2) violated the Administrative Procedure Act by failing to appropriately solicit and incorporate comments from stakeholders.

The American Medical Association together with the American Hospital Association is also expected to file a lawsuit this week in a federal court in the District of Columbia to raise similar legal challenges to the federal agencies’ interpretation of the NSA. MSSNY has had several discussions with the PAI regarding how together they can best assist the AMA in pursuing this legal action, including filing an amicus brief.

Since the NSA’s passage last December, MSSNY working together with many other medical associations across the country have written to and met with federal regulators to encourage rules to ensure a fair implementation of the NSA, including a MSSNY letter to federal officials this week. Like many other groups, the MSSNY letter raised strong objections to federal regulations because, instead of following the statutory language included within the NSA, HHS and other federal agencies designed an IDR process for resolving out of network surprise medical bills that heavily favors health insurance companies in payment disputes by prioritizing health insurer median contract rates over other factors.

The Congressional intent articulated in the NSA was to create an IDR process to protect patients that was appropriately balanced and did not favor either the insurer or the physician in claims disputes. Specifically, the final language adopted by Congress required that numerous factors be considered, including patient acuity or complexity of services, demonstrations of previous good faith efforts to negotiate in-network rates and previously contracted rates, in addition to the insurers’ median in-network rate, without specifying that one factor take precedence over another.

Physicians must also be aware that there are numerous other changes required by the NSA that will take effect January 1 that will impact New York physicians which are not the subject of these legal actions. MSSNY has written multiple newsletter articles that have sought to educate physicians regarding many of the important differences between the NSA and New York’s existing surprise bill law.


MLMIC Ad


MSSNY Comments on COVID Vaccines for Children in USA Today Network and Boosters for Adults on WROC-TV
Some New York Counties Lagging Behind Statewide Rate Of COVID-19 Vaccinations Among Children Aged 5 To 11
The Lower Hudson Valley (NY) Journal News (USA Today Network) reported, “COVID-19 vaccinations among New Yorkers ages 5 to 11 have slowed recently and some counties are lagging far behind the statewide rate.” About 18% of children “in the 5-11 age group have received their first dose, but nearly 40 of the 62 counties statewide fell below that rate, state data on Friday showed.” The article added that “last month, parents who anxiously awaited the approval rushed to get children vaccinated in the early weeks, but demand has waned recently, said” Medical Society of the State of New York President Joseph R. Sellers, MD. Dr. Sellers explained, “There is a group of parents who don’t want themselves vaccinated and don’t want to vaccinate their children, and those are very difficult conversations. … Then, there is a group in the middle that are not sure and need some reassurance, and that’s where we as medical professionals are putting our efforts.”

Encourage Booster Shots to Combat Rising COVID-19 Infections in New York
WROC-TV Rochester, NY reported Monroe County, New York is “under a state of emergency…due to being low on hospital bed spaces and COVID-19 cases still increasing.” On Saturday, “the first group of 26 National Guard Medics” were deployed to “help nursing home staff open more bed space to get recovered elderly patients out of hospitals.” Physicians “and government officials believe the next way to curve the rise in cases” and lower hospitalizations “is getting take-home COVID-19 test kits out to pharmacies, clinics, and physician offices.” Still, physicians “agree the best weapon is getting the vaccine, especially boosters with Omicron now rising.” MSSNY President Joseph R. Sellers, MD, said, “What the booster shot does is it takes the immunity to a higher level of immunity and protection. So, anybody who has been out six months from either Moderna or Pfizer or more than two months from the Johnson and Johnson vaccine we recommend getting a booster.”


Insurance Banner Ad


MSSNY Tip of the Week: Guide to Value Based Contracting
Value Based Contracting (VBC) is becoming more relevant and widely used. A VBC is a specialized contract between the physician and the insurance company that focuses on multiple areas, including clinical performance and agreed upon pre-determined financial and patient targets that need to be met to achieve rewards (shared savings or bonuses).

A significant component of the VBC is quality-based performance that will yield per-member per-month (PMPM) reimbursement. There is much to know before you enter into a VBC to see if it is right for you. View guidelines from Physician Advocacy Institute to assist in making the right choice for your practice.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | hlopez@mssny.org 


Why I’m a MSSNY Member: Lance Austein,  MD, FACP

Photo of a physician


Tomorrow! MSSNY Micro Masterclass Webinar:  Submitting Formal Insurer Complaints to the Appropriate Agency
Do you have unresolved claims payment issues with an insurer? Not sure how to pursue a resolution? Settle in with your lunch and join Heather Lopez, Director of MSSNY’s Payment and Practice Division, at 12:15 pm on December 9 for a 15-minute masterclass on filing and following up on insurer complaints. Heather will share information on how to determine the proper agency for the complaint as well as providing contact information for each of the agencies. Please register to join us for the webinar.



Garfunkel Banner Ad


Attention MSSNY Resident and Fellow Members
You were recently sent a survey asking for your input as to how MSSNY CAN HELP YOU…WE NEED YOUR FEEDBACK!

Please check your e-mail and submit your responses.  You are a significant part of MSSNY, and your input is important to us! You can also click here to access the survey.


32 Hospitals Directed to Limit Non-Essential Procedures Based Upon DOH Criteria
32 hospitals across the State have been ordered by the NYS Department of Health (DOH) to limit non-essential surgeries and procedures starting tomorrow, December 9, based upon their limited bed capacity within their facilities.  The hospitals were ordered based upon the criteria articulated in a DOH “Dear Administrator” Letter (DAL) issued last Friday December 3.

As noted in a MSSNY e-news article last week, as part of a meeting with MSSNY physician leaders and staff, key health staff to the Hochul Administration indicated that a key goal in implementing such a policy is that it be far more measured than previous iterations of elective surgery restrictions.   A few of the notable components of the DAL include:

  • The restrictions on elective surgeries do not apply to procedures performed at specialty facilities (such as a cancer treatment facility), non-hospital owned ambulatory surgery centers (ASCs), office-based surgery practices, or free-standing diagnostic and treatment centers.
  • The limitations will apply to only those facilities that are in regions of the State considered to be high risk (as defined in the DAL) AND have less than 10% bed availability. The 32 hospitals ordered to limit their elective procedures are located in the North Country, Capital District, Mohawk Valley, Finger Lakes and Western New York regions of New York State (see list below).
  • It does not impact services provided by ASCs owned by these impacted Facilities unless the Impacted Facility has less than 5% bed availability based on the previous 7-day average
  • The following procedures are considered essential, and not subject to the restrictions.
    • Cancer, including diagnostic procedure of suspected cancer
    • Neurosurgery
    • Intractable Pain
    • Highly symptomatic patients
    • Transplants
    • Trauma
    • Cardiac with symptoms
    • Limb threatening vascular procedures
    • Dialysis Vascular Access

Moreover, there is an important “catch all” provision to provide flexibility to physicians and their patients to enable procedures not listed above at these restricted facilities where “Patients are at a clinically high risk of harm if their procedures are not completed”

MSSNY is continuing to work with various groups to identify possible gaps in the availability of urgently needed patient care arising from this restriction on elective procedures. 


Premier Banner Ad


New Compliance Date Set for NY Workers’ Compensation Drug Formulary Regulations (Refills and Renewals)
The NY Workers’ Compensation Board recently issued a bulletin providing an update on the implementation of its new formulary regulations (Subject Number 046-1475). The bulletin reminds WC payers to notify injured workers, their physicians, and their health care providers that refills and renewals of prescription medication must conform to the Formulary within six months of the effective date of the regulation. However, as a result of the COVID-19 pandemic, this deadline was postponed.

On November 15, 2021, the Board announced that refills and renewals must comply with the Formulary before the launch of its new business information system. This system, known as OnBoard: Limited Release (OBLR), is expected to launch in the first quarter of 2022. The Board will announce the rollout date of OBLR, via a WCB Notification email, at least four weeks before launch.

To ensure that physicians and injured workers have adequate notice to prepare for the new compliance date, payers must do the following on or before January 5, 2022:

  • Notify physicians and other health care providers of any injured workers they are currently treating with non-Formulary medications so they can either change medications or submit prior authorization requests to continue using the non-Formulary medications.
  • Notify injured workers (claimants) who are currently prescribed non-Formulary medications, so they can discuss medication options with their treating physician or health care provider.

These notifications must be issued by WC payers using a format prescribed by the Chair. Please see Injured Worker Formulary Notification and Provider Formulary Notification for the required format.

The bulletin further notes that health care providers and injured workers may receive WCB notification e-mails to ensure that they are notified of the exact date for compliance. Sign up for these emails using this link.


Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
With just a few weeks left in the year, physicians are again urged to contact Governor Hochul’s office to Urge Governor to VETO Regressive Liability Bills (p2a.co) that she veto multiple problematic pro-trial lawyer bills that if signed could have the effect of significantly disadvantaging defendants generally in litigation in New York State, including physicians and hospitals defending against malpractice claims. 

While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts.  These bills include:

  • A2199/S473 – Expands the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal. 
  • A8040/S7093 – Changes a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.


CPH Banner


Medical Updates & Immunization Site Training for All Healthcare Providers led by Pfizer Vaccines US Medical Affairs
Join Pfizer for a training session to educate providers and immunization staff on the proper use of the Pfizer-BioNTech COVID-19 Vaccine.

Session topics include:

  • Use of the vaccine for:
  • Children 5 through 11 Years of Age
  • Individuals 12 Years of Age and Older
  • Storage, Handling, Preparation & Administration for the multiple presentations of the vaccine
  • Recent medical updates regarding the vaccine
  • An overview of healthcare provider resources
  • Question and answer session

These sessions will be updated to reflect new information and changes that evolve. Recent updates will be identified at the start of each session.

To access current and future training sessions, please visit:

https://www.pfizermedicalinformation.com/en-us/medical-updates


NYS DOH Releases New Information on Cannabis Use During the Perinatal Period
The New York State Department of Health’s Pregnancy Risk Assessment Monitoring System (PRAMS) website has been updated with a new publication: Data to Action: Cannabis Use During the Perinatal Period: Individual Perceptions and Clinician Advising, New York State, 2017-2018.

On March 31, 2021, the Marijuana Regulation & Taxation Act (MRTA) was passed for legalizing adult-use cannabis in New York State. The MRTA created a new Office of Cannabis Management, governed by a Cannabis Control Board to comprehensively regulate cannabis in New York State. With legal accessibility to cannabis for medical and recreational purposes increasing throughout the nation, it is important for reproductive-aged individuals in NYS and elsewhere to understand the health effects of using cannabis before becoming pregnant, during pregnancy, and while breastfeeding. For clinicians, understanding the prevalence of cannabis use, and perceptions of cannabis use among reproductive-aged individuals informs their practice and advances population health.

This Data to Action provides important baseline data on cannabis use among individuals in the perinatal period (before, during pregnancy and after giving birth), their perceptions about cannabis use while breastfeeding, and interactions with providers regarding cannabis use. This information will be invaluable moving forward with the implementation of the new legislation and underscores the importance and need for screening and education for this vulnerable population from health care providers. These data highlight the need for broader outreach to health care providers and public health professionals about the importance of assessing cannabis use and educating people of reproductive age about potential risks of cannabis use during pregnancy and while breastfeeding.

For more information on the NYS Office of Cannabis Management please visit cannabis.ny.gov. Sign up for updates here.


Ads Available for:

Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate

For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302 


For the MSSNY 2021 Ad Rate Sheet, please click here.


Office Space for Lease – Great Neck, NY
Large, fully equipped space available for lease up to 7 days per week. Includes onsite parking and is close to mass transit. Call 516-972-2986 for info.


Rheumatology Practice Opportunity – Great Neck, NY
Opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join, share or merge practices. Fully equipped office with onsite parking and proximity to mass transit. Contact 516-972-2986 for more info.

 

 

 

 

 

 

 

 

 

Congress Must Take Immediate Action to Prevent Medicare Physician Payment Cuts

Media Alert Banner

For Immediate Release 
December 7, 2021 

Congress Must Take Immediate Action to Prevent Medicare
Physician Payment Cuts

Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York 

“With only a few weeks to go before an enormous 10% cut in Medicare physician payments goes into effect, it is imperative for the US Congress to take action before the end of the year to prevent this cut which could have disastrous impacts on seniors’ continuing access to their physicians.

“The cut is prompted by a number of policies that are expiring at the end of the year. The implications of this potentially precipitous cut was made more clear by last week’s report that overall Medicare spending on physician services dropped a staggering 14% in 2020 (Medicare spending on physician services declined $13.9 billion in 2020 | American Medical Association (ama-assn.org), further highlighting the fragility of many community-based physician practices across the country.

“We thank the many members of the New York Congressional delegation who recently joined a letter to Speaker Pelosi and Leader McCarthy urging action to prevent these cuts, but we are nearly out of time.   We urge immediate action to help ensure that community-based physicians will still be able to provide the health care services that are expected and deserved by our patients.”

# # #

Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents, and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.  

Media Contact:
Roseann Raia | Communications / Marketing
Medical Society of the State of New York
865 Merrick Avenue
Westbury, NY 11590
516.488.6100 x302 | rraia@mssny.org

 

1 2 3 4 69