MSSNY eNews: June 21, 2019 – A Funny Thing Happened on the Way to Legalization
As the NY State Budget was being prepared, revenue generated from the legalization of “adult use” marijuana figured prominently in Albany’s calculus.
The State Department of Health released a 96 page report which concluded that the benefits outweighed any risks of legalization. “Listening tours,” usually the sign of a done deal, were held all over NY State. While these meetings were being scheduled, then MSSNY President, Dr. Thomas Madejski of Orleans County didn’t just say no. Dr. Madejski said: “Hell, No” as he recruited physicians all over the state to testify at these meetings.
Slowly, the tide began to turn as not only MSSNY but law enforcement, substance use specialists and county health departments weighed in. Then, enter the PTAs. That did it. Marijuana was no longer a part of the budget. The legislators now worked on stand-alone bills for legalization. However, at this point, articles began to appear in the press which countered many of the arguments in favor of legalization. Visits to Emergency Departments had increased. Revenues were less than advertised. Legalization had not eliminated the black market. Big Pot was poised to supplant Big Tobacco.
Dr. Madejski’s “Just Say Know” campaign on social media soon attracted allies from other states as NJ and CT also threw up roadblocks to legalization. While the dust has not quite settled in Albany, it’s now clear that Albany’s “done deal” is indeed done. Legal recreational pot in NY State is not happening in 2019.
Willie Nelson won’t be celebrating in Albany this year.
Horatius at the Bridge
When the goodman mends his armor,
And trims his helmet’s plume;
When the goodwife’s shuttle merrily
Goes flashing through the loom;
With weeping and with laughter
Still is the story told,
How well Horatius kept the bridge
In the brave days of old.
By Thomas Babington, Lord Macaulay
Arthur Fougner, MD
Comments? firstname.lastname@example.org; @mssnytweet; @sonodoc99
This Week’s Podcast of MSSNY’s Legislative Priorities
Legislative Session Wrap Up; Brings Several Positive Outcomes for Physicians
The State Legislature worked through the night to wrap up its 2019 Legislative Session, one of the most memorable in recent years given the breadth of issues the Legislature decided to address following the power-shifting election which occurred last November. Despite the many threats we faced, the Session produced several “wins” for physicians and their patients, though some adverse bills were also passed that will require MSSNY and others to request vetoes from the Governor.
Your DGA staff thanks the many physicians and county society staff who took the time to make phone calls, write letters, send tweets and personally meet with their local legislators on the myriad of issues which we prioritized our advocacy. Moreover, we thank the numerous specialty societies we regularly partnered with to help achieve these outcomes. Among the highlights of the last few weeks of Session:
- Enactment of legislation supported by MSSNY which ensures that medical contraindications are the only acceptable exception to vaccine requirements;
- Passage of legislation supported by MSSNY which significantly curtails health insurers making mid-year changes to their prescription formularies; or increasing patient cost sharing;
- Passage of legislation supported by MSSNY which will provide extensive new regulation of Pharmaceutical Benefit Managers (PBM);
- Passage of legislation supported by MSSNY that permits a prescriber to arrange with a pharmacist to “partially fill” a patient prescription for opioid medication;
- Passage of legislation supported by MSSNY to reduce insurer prior authorization (PA) requirements when a PA for a related procedure has already been received;
- Defeat of legislation opposed by MSSNY that would have legalized adult use marijuana, as well as proposals that would have significantly expanded the medical marijuana program. Instead legislation was enacted supported by MSSNY that provides further “decriminalization” of small amounts of marijuana;
- Defeat of every major scope of practice expansion bill opposed by MSSNY, including pushing back against aggressive efforts by podiatrists and optometrists;
- Defeat of numerous trial lawyer backed bills opposed by MSSNY which could have greatly expanded lawsuits or damage awards against physicians, or made it much more difficult to defend a lawsuit. It should be noted that the Legislature did pass a couple of smaller measures opposed by MSSNY and many other groups that will affect certain cases involving multiple defendants and where an adverse judgment has been reached;
- Defeat of several bills opposed by MSSNY that would have overridden physician clinical judgment and added even more requirements on physicians prior to prescribing opioid medications to patients.
Physician Advocacy Urged to Prevent Congressional Attempts to Undermine New York “Surprise Bill” Law
Physicians are urged to send a letter Please click Here: to Senators Schumer and Gillibrand, as well as your local US Representative, urging your member of Congress to fight for a “surprise medical billing” law that is consistent with New York’s approach. This week, US Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) released a bill that would seriously undermine New York’s proven model and greatly diminish the ability of physicians to fairly negotiate patient care terms with market dominant health insurers.
Instead of the disastrous Alexander-Murray bill, MSSNY and many other physician advocacy organizations have praised a proposal advanced by Representative Joe Morelle (D-Rocheseter) together with Representative Dr. Phil Roe (R-TN) and Dr. Raul Ruiz (D-CA), that seeks to mirror New York’s law, which uses a “baseball arbitration” Independent Dispute Resolution (IDR) system to determine payment for out of network medical care, and uses charge data collected by an independent database as a leading benchmark to guide the IDR.
Specifically, the Alexander-Murray bill would require an insurer determined in-network based default rate for out of network surprise medical bills. This would give enormous new powers to already market dominant insurers, and fails to recognize the insurance industry’s fault in creating this problem due to their narrow networks. MSSNY has written to New York’s Congressional delegation praising the approach set forth by Representatives Morelle, Roe and Ruiz, and raising strong concerns with other proposals. Specifically, New York’s letter raised concerns with the insurance industry’s own notorious history in establishing benchmarks for out of network payment, and the history of then-Attorney General Cuomo’s investigation which found that by using a flawed and conflicted database to determine reimbursement rates for out-of-network care, insurers were increasing profits at the expense of patients and physicians.
Moreover, it was noted that New York’s law struck a tenuous balance among various health care stakeholders that protected patients from surprise medical bills and assured that hospital emergency departments had access to needed on-call specialty care.
MSSNY has been working with several other state medical associations and national specialty societies in its advocacy to Congress. Please see here for a short “Fact Sheet” developed by the Physicians Advocacy Institute that sets forth key principles for Congress to consider in this debate Please click here: (AUSTER)
NYS Legislature Moves to Decriminalize Marijuana; Does Not Permit Legalization of Marijuana
Legislation to permit the legalization and commercial sales of recreational use marijuana did not happen this year. However, a measure to decriminalize possession of small amounts of marijuana was successful. A.8420A/S.6579A, sponsored by Assembly Majority Leader Crystal Peoples-Stokes and Senator Jamaal T. Bailey, provides for further decriminalization of certain low level marijuana possession offenses and for expungement of the records. Governor Cuomo has indicated that he will sign this measure. The Medical Society had also indicated for support of the measure as it was consistent with MSSNY policy.
The legislature also did not act on legislation to expand the medical marijuana program, through a bill opposed by MSSNY that would eliminate the “serious condition” threshold for certifying a patient for medical marijuana, enable smoked versions of medical marijuana, and allow any “practitioner” who is authorized to prescribe controlled substances with the state to certify a patient for medical marijuana use.
MSSNY worked with the New York State Association of County Health Officials (NYSCHO), the PTA, the NYS Sherriff’s Association and Smart Approaches to Marijuana (SAM) in getting a unified message to the legislature about the potential impact of marijuana on young people as well as the adverse public health impacts in other states. MSSNY also credits several members of the Legislature with bringing those concerns back to the members of their respective houses. (CLANCY, AUSTER)
Legislature Passes Bill to Curtail Mid-Year Formulary Changes by Health Plans
The Senate and Assembly gave final passage to legislation this week that would substantially limit the ability of health insurers to make changes to their prescription medication formularies during a policy year.
The legislation (A.2969, People-Stokes/S.2849, Breslin) would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year. Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year.
The legislation does permit an insurer to move a prescription drug to a tier with a larger copayment, coinsurance and different deductible only if an AB-rated generic equivalent drug or interchangeable biological product is added to the formulary at the same time. MSSNY supported this legislation and worked with several patient advocacy organizations to advocate for its passage. (AUSTER, AVELLA)
Pharmacy Benefit Manager Licensure and Regulation Passes Both Houses
Legislation that will require licensure for pharmacy benefit managers (PBMs) and outline their duties and responsibilities has passed both houses and awaits the governor’s signature. Senator Breslin and Assemblymember Gottfried’s bill (S.6531/A.2836A) passed the final week of session and will implement measures to provide clarity and oversight of PBMs and requires PBMs to act in the best interest of covered individuals, health plans and providers.
PBMs will be required to register with the Superintendent of Insurance and will require renewal of their license every three years. Licensure will be contingent upon meeting minimum standards established by DFS and the Commissioner of Health. PBMs will be required to address any conflicts of interest, deceptive practices, anti-competitive practices, and unfair claims practices. They will also be required to disclose plans with whom they contract and terms and conditions placed on their pharmacy networks. Per Trish Riley, the Executive Director of the National Academy for State Health Policy, New York’s policy will go the furthest in the nation toward regulating PBMs. (AVELLA)
Legislature Passes Bill to Reduce Certain Prior Auth Requirements to Prevent Interruption of Patient Care Services
The Assembly and Senate gave final passage this week to a measure to reduce insurer prior authorization (PA) requirements when a PA for a related procedure has already been received. The bill, A.2880-B, Hunter/S.5328-B, Breslin, would ensure that if a physician providing a treatment to a patient for which a PA has been received determines that providing an additional or related service or procedure is “immediately necessary as part of such treatment” and would not be “medically advisable to interrupt the provision of care to the patient” in order to obtain a PA, then the insurer shall not deny the claim, except under limited circumstances.
Specific patient scenarios this legislation is seeking to address include when a patient receiving chemotherapy needs to quickly receive treatment for related health issues, such as nausea, low platelet count or allergic reactions, without the need for the physician to ask and receive an additional PA from the insurance company. MSSNY supported this legislation. (AUSTER)
Partial-Fill Legislation Passes New York State Legislature; Bill Goes to Governor
Assembly Bill 3918 and Senate Bill 1813, Which was sponsored by Assemblymember John McDonald and Senator Gustavo Rivera would allow physicians to prescribe a controlled substance, on a partially filled basis and has passed the New York State Legislature. The measure will now go before Governor Cuomo for his consideration. Passage of this measure allows New York State to align itself with the federal law; partial fills were authorized on a federal level under the Comprehensive Addiction and Recovery Act (CARA).
This measure would allow physicians/prescribers, in consultation with their patient, to prescribe up to a 30 – day supply of a controlled substance with a notation to the pharmacist that he/she should only dispense the agreed – to amount. Each partial filling would be dispensed and recorded in the same manner as a refilling (i.e., date refilled, amount dispensed, initials of dispensing pharmacist, etc.), and the total quantity dispensed in all partial fillings may not exceed the total quantity prescribed.
The Medical Society of the State of New York believes that this measure will now allow prescribers to help patients balance the need to relieve pain with an adequate supply of medication by only filling part of the prescription. Should they need additional pain relief; patients will be able to return to the pharmacy to fill the remaining portion of their prescription. (CLANCY)
Maternal Mortality Board Fine-Tuned on Last Day of Session
Senator Rivera and Assemblymember Joyner passed legislation (S.6529/A.8338) to make technical changes to the maternal mortality legislation board that was passed earlier this year, & supported by MSSNY & ACOG. This bill will ensure that the board’s makeup is representative of the racial, ethnic and socioeconomic diversity of women and mothers in the state and to the extent possible, representative of areas that are medically underserved and areas with high occurrences of maternal mortality and morbidity. It also clarifies how committee members will be appointed and what information the commissioner may request from health departments and other public authorities. (AVELLA)
Cesarean Section Mandate Fails to Pass in 2019
Legislation that would have required physicians and other health care providers to provide maternity patients with written information regarding the risks associated with Cesarean section passed the Assembly, but not the Senate. This bill, S.2888/A.318, which is sponsored by Senator Salazar and Assemblymember Paulin is opposed by MSSNY and the American College of Obstetricians and Gynecologists (ACOG).
This bill was opposed by MSSNY and ACOG for a variety of reasons, including the fact that the bill’s terminology is not consistent with accepted medical practice. Additionally, physicians already seek informed consent – this bill would interfere with the physician-patient relationship by requiring boilerplate, pre-determined written communication. This goes against the concept of patient-centered, custom provision of care that differs from patient to patient.
Further troubling to MSSNY is the recent trend in New York and across the nation to mandate discussions and/or certain actions by physicians. While these measures are well-intended, they do patients a disservice by interfering with their relationship with their doctor and often may prove to be more harmful than helpful. (AVELLA)
Legislature Rejects Liability Expansion Legislation with Huge Premium Impacts; Passes Others Affecting Cases with Multiple Defendants
Despite trial lawyers aggressively pushing the State Legislature on a litany of adverse bills in the Session’s final days, the Legislature left Albany without taking action on many of their priority bills that would have significantly driven up already excessive liability costs for physicians, hospitals and other business entities, and made it far more difficult for a physician to defend themselves in a medical liability action. These bills included legislation that would have: exponentially expanded awardable damages in wrongful death lawsuit (S.4006/A.5612); prohibited a defendant physician’s defense counsel from interviewing a medical malpractice plaintiff’s treating physician (S.6194/A.2370); and permitted the admissibility of certain “hearsay” statements of employees in civil actions (A.7599/S.6335).
With significant objections from MSSNY, numerous specialty societies, HANYS and GNYHA, the Legislature did pass 2 bills affecting certain cases involving multiple defendants where the jury has awarded a judgment for the plaintiff, including:
- A.2372/S.6081 – would permit a plaintiff to collect on a court judgment directly against a third party defendant that had been sued by the original defendant for contribution and indemnification. The concern is that this type of practice could encourage those parties unable to satisfy their apportioned share of liability to dodge their responsibility, while allowing a plaintiff to target a deep-pocketed third party.
- A.2373/S.6552 – would require a non-settling co-defendant in a tort action, where another co-defendant has settled, to choose whether to reduce his/her liability exposure by the stated settlement amount or the settling tortfeasor’s equitable share prior to a trial, instead of after a jury verdict has been reached. The concern is that it forces the non-settling defendants to make a blind choice without knowing the ultimate outcome of the trial, with the risk that if the co-defendant makes the “wrong choice”, a plaintiff could receive a recovery above what the jury awarded.
MSSNY will be working with other groups to request that the Governor vetos these 2 bills given their likely inflationary impact on overall medical liability costs, which already are by far and away the highest in the country. (AUSTER)
Legislature Passes Bill to Provide Greater Clarity to Medical Record Disbursement When Physician Retires
The Senate and Assembly gave final passage this week to legislation setting forth procedures to follow when a physician or other health care practitioner decides to cease to stop providing patient care in New York State. The goal of the legislation (A.2349/S.5367) is to address the often-asked question of where patient records should be sent when a physician or other care provider retires from medical practice or moves to another state. Specifically, the legislation requires the practitioner, at least 30 days prior to ending their practice, to make a good faith effort to notify the practice’s “current patients” of the impending closure and of the patient’s right to request their patient information or medical records be sent to the health care provider, facility, or practitioner of their choice or returned to the patient.
The bill does not define what is considered to be a “current patient”. The bill does, however, clarify that the provisions of the bill do not apply to situations where a physician’s practice is acquired or merged with another entity, and the physician continues to deliver care to patients. MSSNY is continuing to review the legislation with its General Counsel and will submit comments to the Governor’s office when the bill is delivered to the Governor. (AUSTER)
Opioid Measures Not Acted on By Legislature
There were several measures that related to opioid prescribing that would have imposed even more requirements on physicians prior to prescribing opioids that failed to win passage. The bills are:
- 8256/S.5867A, moved to the Assembly calendar but was not voted on by the full Assembly. This legislation would have amended the public health law to require health practitioners, before prescribing an opioid medication, to consider discussing with the patient and refer or prescribe alternative services such as chiropractic, massage therapy or behavioral therapy.
- 5603/S.5150, moved to the Assembly Ways and Means Committee and to the Senate calendar but was not acted on by either house. This legislation would have amended the public health law to require that prescribers, who prescribe opioids for the first time must also co-prescribe an opioid antagonist with the prescription.
- 7285A/S.4277A, passed the Senate but was not acted upon in the Assembly. The legislation would have amended the public health law to require health practitioners who prescribe an opioid or other Schedule II Controlled Substance to discuss with the patient the risks of being prescribed a CSII drug, other co-prescribe an opioid antagonist.
Efforts to Expand Scope of Practice Legislation Pending on Senate Calendar for a Vote
There are several bills that would have expanded the scope of practice of various professions that moved forward in the New York State Senate but failed to win approval in the Assembly. MSSNY worked together with several specialty societies to advocate on these issues. The Medical Society had opposed the following measures:
- 5395/A.6185, would have inappropriately expanded the scope of practice of podiatrists the following ways: by reducing certification requirements for podiatrists seeking to have advanced surgical privileges; removing the requirement that a podiatrist seeking either standard ankle surgery or advanced ankle surgery privileges be directly supervised by a podiatrist with an advanced license from the NYSED or a physician; and enabling podiatrists to treat wounds that are not contiguous with structures of the foot or ankle. This measure was approved by the Senate, but failed in the Assembly.
- 1193, would have permitted Optometrists to prescribe oral antibiotic and other medications. The bill failed to advance out of the Higher Assembly Ed committee.
- 5092/A.3867, would have added pharmacists to the list of licensed health care professionals authorized under public health law to perform non-invasive laboratory tests as an adjunct to their professional services, without an order from a physician. The measure advanced in the Senate, but failed to move in the Assembly.
- 5227/A.6511A, would have allowed pharmacists to provide ALL immunizations on the Advisory Committee on Immunizations Practices (ACIP) list recommended for adults.This would more than double the number of immunizations pharmacists would be permitted to provide. The measure advanced in the Senate, but failed to move in the Assembly.
- 4975/A.6486, would have authorized a pharmacist to administer vaccines for hepatitis A, hepatitis B, and human papillomavirus to adults via a patient or non-patient specific script. The measure advanced in the Senate, but failed to move in the Assembly. (CLANCY, AUSTER)
Joint Statement Issued by DOH, Office of Children and Family Services, SED on Non-Medical Exemptions—Measles Outbreak Continues
The New York State Department of Health, the Office of Children and Family Services, and the State Education Department has issued a joint statement on the law that removed non-medical exemption from school vaccination requirements. According to the statement, as of June 13, 2019, “there is no longer a religious exemption to the requirement that children be vaccinated against measles and other diseases to attend either a public, private or parochial school (for students in pre-kindergarten through 12th grade or child day care settings.”
For those children that have had a religious exemption to required immunizations, they must receive their first age appropriate dose in each immunization series by June 28, 2019 to attend or remain in school or child care. A copy of the joint statement and Frequently Asked Questions about the legislation can be found at: Please click Here.
Physicians and other providers who provide immunizations to children are advised to be prepared to see an increase in children who need these vaccines and to try their best to accommodate them into their practice. As summer and travel begins, there will be an increased demand for immunizations for both children and adults. The measles outbreak continues to grow in New York State. There is continued ongoing transmission of measles in communities in NYS with the majority of cases in those who are unvaccinated or under- vaccinated. The New York State Department of Health has issued a June 14, 2019 health advisory that says: Please click Here
- Since October 1, 2018, there have been 932 cases reported in NYS: including 267 in Rockland County, 49 in Orange County, 18 in Westchester County, 8 in Sullivan County, and 588 in New York City (NYC).
- Providers should NOT rely upon self-report of vaccination as evidence of immunity. If there is no record of vaccination or evidence of immunity (and no contraindication), the patient should be vaccinated.
- For adults in outbreak areas, the NYSDOH recommends administration of a second dose of a measles-containing vaccine (MMR) for adults with one documented dose of a measles-containing vaccine.
- For adults in non-outbreak areas, recommendations have not changed. One dose of a measles containing vaccine (or other presumptive evidence of immunity) is sufficient for most adults.
- Healthcare providers need to maintain vigilance for measles and immediately report any suspect cases by telephone to the local health department (LHD) where the patient resides. (CLANCY)
A Big Thank You for Physician Advocacy Efforts!
MSSNY’s Physician Advocacy Liaison (PAL) network was instrumental in helping to achieve our numerous legislative victories, by helping us quickly respond to legislators who needed to hear the physician perspective on a number of issues. As always, thank you for the work all of you do on a daily basis, and for taking the additional time to be active in the legislative and budgetary process. There is no doubt that your efforts were a major contributor to our successes.
While another legislative session has wrapped up in Albany, MSSNY is still actively looking to expand the PAL network. The PAL network is a vital way for elected officials to hear directly from their physicians and a way to make certain that our leaders remain committed to championing the issues that matter most to MSSNY members and their patients.
For more information on the PAL network or to sign-up, click Please click Here: (HARRING)
Measles Outbreak in New York State Continues to Spread Webinars Available at MSSNY CME Website
Did you know that 90% of the 1,044 measles cases in the United States are right here in New York? The number of measles cases in New York State in 2019 has again seen an uptick over the past week. 943 of the 1,044 confirmed cases nationwide are in New York State. In 2019 there have been 596 confirmed cases in New York City and 323 outside of New York City (268 in Rockland; 51 in Orange; 18 in Westchester; 8 in Sullivan; 1 in Suffolk and 1 in Greene counties) confirmed cases as of June 17th. MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.
This webinar has now been posted to the MSSNY CME website. You can also view MSSNY’s latest Medical Matters webinar entitled “What’s Your Diagnosis? Infectious Diseases” which involves a patient with a fever and a rash. Please check these out and keep yourself informed about the growing measles outbreak throughout New York State. You can also listen to MSSNY’s newest podcasts on the current measles outbreak for both physicians and patients At as well as a brief podcast on the Measles, Mumps and Rubella vaccine at the same site. (HOFFMAN, CLANCY)
Please Join Us for MSSNY’s Physicians’ Day at the Races
MSSNY’s 2nd Physicians’ Day at the Races will take place on Saturday, July 27, 2019 at the Saratoga Race Course “The Rail at the 1863 Club” in Saratoga Springs, NY.
Please join your friends and colleagues for a great event to benefit your profession. MSSNY uses its resources and mobilizes support from elected officials who will stand and fight for us, regardless of what party they are from. MSSNYPAC allows us to pool our resources and together, make a difference against other special interest that continues to try to undermine the delivery of quality health care. MSSNY continues to develop new fundraising opportunities for our physicians to become more active.
Ticket price includes clubhouse admission, post parade programs, a gourmet buffet lunch at your own trackside table (11:30am-2:30pm), open bar, private viewing of the horses as they bring them from the paddock and private betting windows with a 1:00pm post time.
NYS Workers’ Comp Board to Provide Training at Regional Conferences
The New York State Workers’ Compensation Board (Board) has announced a series of three regional conferences to take place this summer in Albany, Rochester, and New York City. The half-day, afternoon sessions are open to anyone with an interest in the New York State workers’ compensation system, and will highlight important advances in workers’ comp, as well as provide Continuing Legal Education (CLE) and Continuing Medical Education (CME) courses.
The conferences come on the heels of several significant Board initiatives, including New York’s first drug formulary and revised medical fee schedules that provide higher reimbursements to health care providers who treat injured workers. Additionally, the Board is gearing up to implement a new law that takes effect on January 1, 2020, that enables more types of health care providers to be authorized to treat workers’ compensation patients. In addition to a general overview highlighting recent accomplishments, attendees can also choose other sessions to attend for a deeper dive into key topics, such as:
- Legal update: significant case law, developments in adjudication and legislation (CLE)
- Ethical considerations in appearing before the Board (CLE)
- Medical marijuana in NYS workers’ compensation (CLE/CME)
- Impairment guidelines for determining schedule loss of use (CME)
- Understanding variances and the drug formulary (CME)
- Combatting fraud
- Best practices in workers’ compensation
- Intro to workers’ compensation for new providers
The regional schedule is below:
Monday, July 1
Empire State Plaza Convention Center
Concourse Level Albany, NY 12242
Wednesday July 31
Hyatt Regency Rochester
125 East Main Street
Rochester, NY 14604
- New York City
Monday, August 5
New York Marriott Downtown
85 West Street at Albany Street
New York, NY 10006
The cost is $50 to attend, with hardship scholarships available to those who qualify. Registration is limited and will be granted mainly on a first-come, first-served basis. However, special consideration will be given to those seeking CME/CLE credits.
For complete details and to register, visit bit.ly/WCBconference19.
Attention: All Physicians
Do You Know about Having to Research Exclusionary Databases of Your Managing Employees?
MSSNY has heard from several physicians and specialty societies regarding the significant burdens associated with a requirement that managed care companies are imposing on its participating physicians to check numerous databases on a monthly basis. The Office of the Medicaid Inspector General (OMIG) checked with their Office of Counsel (OOC) and it’s their interpretation of the contract that MCOs must require their participating providers to check exclusion lists for their managing employees, not all their employees.
Network physicians are being instructed by managed care organizations to conduct routine checks of Federal and State databases. These include the Social Security Administration’s Death Master file, and the National Plan and Provider Enumeration System (NPPES), and the Excluded Parties List System (EPLS), and either the List of Excluded Individuals and Entities (LEIE) or the Medicare Excluded Database (MED), the NYS OMIG Exclusion List, and any such other databases as the Secretary may prescribe; and check the LEIE (or MED), the EPLS and NYS OMIG Exclusions List no less frequently than monthly.
The NYS DOH has stated that this is a requirement for providers seeing Medicaid patients (and receiving public dollars), whether they are in FFS or managed care. Plans are enforcing the requirement.
NYS Buprenorphine Waiver Eligibility Trainings for Clinical Providers
The NYSDOH AIDS Institute in partnership with various local health departments are sponsoring free Buprenorphine Waiver Eligibility Trainings for Clinical Providers. In response to opioid overdose deaths in New York State, increased access to buprenorphine treatment for Opioid Use Disorder (OUD) is urgently needed. Physicians, Nurse Practitioners, Physician Assistants and Medical Residents are highly encouraged to attend.
Under current regulations, authorized practitioners (MDs, DOs, NPs & PAs) are required to obtain a ‘waiver’ to prescribe buprenorphine. To acquire this waiver, physicians are required to complete a standardized 8-hour buprenorphine waiver training.
Nurse Practitioners (NPs) and Physician Assistants (PAs) are required to complete the 8-hour buprenorphine waiver training as well as an additional 16 hours of online training as established by the Comprehensive Addiction and Recovery Act (CARA). Residents may also take the course and apply for their waiver once they receive their DEA license. The 8-hour buprenorphine waiver training is offered in a ‘half and-half’ format [4.5 hours of in-person training followed by 3.5 hours of online training]. Upon completion of the required training, providers will meet the requirement of the DATA 2000 to apply for a waiver to prescribe buprenorphine for opioid-dependent patients. Visit PCSS for more info including how to complete of all required training online:
- June 22nd: Ulster County (Kingston), 8AM-1PM, Registration: https://bit.ly/2Z5XpHL
- June 26th: Suffolk County (Great River), 1PM-6PM, Registration: email email@example.com by June 21st.
- June 29th: Onondaga County (Syracuse), 8AM-1PM, Registration: https://bit.ly/2IinYnH
- July 12th: Nassau County (Bethpage), 8AM-1PM, Registration: https://bit.ly/2WGpzrr
- August 14th: Broome County (Johnson City), 4PM-9PM, Registration: https://bit.ly/2MLcPjq
*For more information about waiver trainings held outside of NYC, email firstname.lastname@example.org
*For more information about waiver trainings held in NYC, email email@example.com
Coalition Wants Johns Hopkins to Drop Medical Debt Suits v. Low-Income Patients
A coalition of Baltimore citizens, backed by two unions, presented a letter and petition June 17 to Baltimore-based Johns Hopkins Hospital President Redonda Miller, MD, calling on the hospital to drop medical debt lawsuits against patients.
The group, called the Coalition for A Humane Hopkins, published a joint report with National Nurses United and AFL-CIO last month that found the hospital won wage garnishments or seized funds from patient bank accounts in more than 400 cases. The groups claim the hospital seized the last $100 in a patient’s bank account in at least two instances. The report also alleges this issue disproportionately affects a primarily African American and low-income zip code in Baltimore.
The coalition wants the hospital to stop filing medical debt lawsuits, drop all current medical debt lawsuits and reimburse patients billed more than allowed under charity care rules. It also wants the hospital to be more transparent about its charity care rules by increasing signage and screening patients at admission to see if they are eligible for charity care. Lastly, it wants the hospital to offer charity care to patients who are not citizens of the U.S.
However, Johns Hopkins spokesperson Kim Hoppe said the hospital does provide financial assistance and charity care information to every patient.
Ms. Hoppe provided Becker’s the following statement:
“It is always our priority to provide the best possible care to every patient who comes to us. We have an extraordinary community benefits program, and it is our policy to inform our patients about our programs for free and discounted services. For patients who choose not to pursue those options or who have a demonstrated ability to pay, we will still make every effort to reach out to them and to accommodate their schedule and needs. In those rare occasions when a patient who has the ability to pay chooses not to, we then honor our obligation as a hospital in the state of Maryland, with its unique payer model, to pursue reimbursement.” (Beckers Hospital Review June 18)
Under Financial Pressure, US Citizens Travel to Canada to Buy Insulin
Between 2012 and 2016, the cost of insulin for treating Type 1 diabetes nearly doubled, according to the nonprofit Health Care Cost Institute,” and insulin can cost hundreds of dollars per vial in the US. Now, some people are traveling to Canada to buy the treatment, where insulin can be purchased “without a prescription for a tenth of” the price. Similarly, “Republicans and Democrats have produced federal and state proposals to import drugs from Canada.” Department of Health and Human Services spokeswoman Caitlin B. Oakley wrote in an email, “President Trump and [HHS] Secretary Azar are firmly committed to getting drug prices down.” Meanwhile, many Canadians “worry that bulk [insulin] buys from the United States could cause shortages or higher prices.” Washington Post (6/16)
Drug Cos. Sue HHS over Rule Requiring Them to Include List Prices in TV Ads
An effort “by the Trump administration to shine light on the high costs of prescription drugs prompted legal resistance by three major pharmaceutical companies.” The article said, “Amgen, Eli Lilly, and Merck sued the Department of Health and Human Services in a bid to block new rules requiring that companies disclose the ‘list price’ of their drugs in television advertising.” The companies “called the rules ‘entirely unnecessary, bad for patients, and detrimental to health care,’ as well as a violation of” their “free speech rights.” The lawsuit names HHS Secretary Alex Azar as a defendant.
Azar said last month when he announced the rule, “Claiming list prices don’t matter is almost the same as claiming there is no problem with high drug costs at all – and I don’t think many American seniors or patients with serious illnesses would say that’s the case.” Azar also stated at the time, “Requiring the inclusion of drugs’ list prices in TV ads is the single most significant step any administration has taken toward a simple commitment: American patients deserve to know the prices of the health care they receive.” Washington Post (6/14)
Join CMS for a Public Webinar on Quality Measurement
CMS is pleased to invite the public to attend its upcoming webinar titled Measuring Quality to Improve Quality: Strengths and Challenges of Clinical Quality Measurement. The webinar will provide an engaging and informative overview of key concepts that go into its quality measures. Additionally, the presentation will review current CMS quality measures, explain how they are used, and how they fit into CMS’s quality goals, including the Meaningful Measures initiative.
The webinar will be offered twice in June, on Tuesday, June 25th, from 2:00-3:00pm EST (Register here) and Thursday, June 27th, from 2:00-3:00pm EST (Register here). Please register in advance if you can attend as space will be limited. We request that you please only register for events you plan to attend. We hope you can join us and look forward to your questions! For questions, please contact MMSSupport@battelle.org.
Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
For Lease – Buffalo Area Urgent Care / Primary Care Clinic
View full listing https://reporting.loopnet.com/report/3008dc65-60b8-4476-ab01-df4ffa2bc628.
Contact firstname.lastname@example.org / (917) 825-4542
Upper East Side Medical Office Space for Rent Part–Time
Park Avenue Office Share-3 Days Per Week
Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email email@example.com for further information.
Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter. Four new exam rooms and dictation room. New stainless and granite kitchenette. State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards. Digital X-ray room with PACS in each exam room available as an option. Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855; Please see our listing: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/
Office Rental 30 Central Park South.
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month.Available full or part-time. 212.371.0468 / firstname.lastname@example.org.
Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical office, shared your office space, buy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up
Multi-Specialty Medical Office Looking To Bring On More Doctors
New York Medicine Doctors Center is a multi-specialty Medical Agency networking some of the best medical professionals and specialists in the New York Tri-State area. Our offices currently serve both Manhattan and Queens, providing a variety of advanced technological on site testing, imaging, and services for the most rapid results.
We are actively looking to bring on board an array of Doctors specializing in Primary Care, Gynecology, Gastroenterology, ENT, Urology, Podiatry, and Dermatology.
As we continue to broaden our medical services in both locations, we also provide individualized on-boarding contracts with health benefits, tailored in-house marketing and advertising, practice management assistance, and in house team of administration dedicated in serving any and all concerns whether it be credentialing or equipment related tasks.
If you are interested in joining our growing network, please do not hesitate to contact us
at 718-360-9550 or 212-931-8533. Our direct email is email@example.com
Primary Contact: Oksana
Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review. We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: firstname.lastname@example.org Fax: (1-516) 833-4760 Equal Oppty Employer M/F
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355