MSSNY eNews: April 22, 2022
Message from MSSNY President Dr Joseph Sellers:
Have Prior Auth Hassles Hindered Care for Your Patients?
With the New York State Budget now behind us, it’s time to refocus our efforts on the six remaining weeks in the legislative session.
The “Gold Card” legislation, which was introduced in the Assembly by Assemblymember John McDonald (D-Albany) and in the Senate by Senator Neil Breslin (D-Albany), would establish a program in which insurers will exempt physicians from a health insurer’s Prior Authorization (PA) requirements for a specific treatment if they receive at least 90% approval for PAs for that specific health care treatment. With the Senate Insurance Committee to consider the legislation next week, all physicians are urged to contact their Senators to express support: Take Action!
As physicians, we are all too familiar with how excessive prior authorization hassles can impede patient care. In fact, a recent AMA survey showed that more than 9 in 10 physicians (93%) reported care delays while waiting for health insurers to authorize necessary care, and 82% said patients abandon treatment due to authorization struggles with health insurers. More than half (51%) of physicians reported that prior authorizations had interfered with a patient’s job responsibilities, and more than one-third (34%) of physicians reported that prior authorization led to a serious adverse event such as hospitalization, disability, or even death, for a patient in their care.
The bill is a new and important part of MSSNY’s ongoing advocacy efforts to confront excessive prior authorization requirements that interfere with patient care delivery and access to the most effective treatments.
It’s time for us to take action. Please share any examples you have of prior authorization hassles that have hindered necessary patient care so that we can bring your anecdotes to the legislators and to regulators with authority to stem the abusive practices of health insurers.
Again, please take a minute to visit MSSNY’s Grassroots Action Center (GAC) to urge your state Senator and Assemblymember to sign on in support of A.9908-A, McDonald/S.8299, Breslin: Take Action!
Joseph Sellers, MD, FAAP, FACP
Urgent Reminder: Provider Relief Fund Requests for Late Reporting Due AT MIDNIGHT
Physicians who received more than $10,000 in provider relief funds and did not submit their Period 1 report must act immediately by submitting a late Reporting Period 1 report request by Friday, April 22, 2022 at 11:59 pm ET. HRSA has informed the AMA that there are approximately 16,000 providers in this situation, accounting for about 2% of Provider Relief Funds disbursed in Period 1. While physician practices should have received information about how to submit a request directly from HRSA via email and US postal mail, we are aware many providers have not been contacted. The emails were sent from UHG_HRSA@ProviderEmail.uhc.com. If a provider did not submit a Period 1 report and does not hear from HRSA, click here to learn more about the late reporting request form or call (866) 569-3522.
When completing the late reporting request, a provider must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. HRSA has released the following as allowable extenuating circumstances:
- Severe illness or death – a severe medical condition or death of a provider or key staff member responsible for reporting hindered the organization’s ability to complete the report during the Reporting Period.
- Impacted by natural disaster – a natural disaster occurred during or in close proximity of the end of the Reporting Period damaging the organization’s records or information technology.
- Lack of receipt of reporting communications – an incorrect email or mailing address on file with HRSA prevented the organization from receiving instructions prior to the Reporting Period deadline.
- Failure to click “submit” – the organization registered and prepared a report in the PRF Reporting Portal but failed to take the final step to click “submit” prior to deadline.
- Internal miscommunication or error – Internal miscommunication or error regarding the individual who was authorized and expected to submit the report on behalf of the organization and/or the registered point of contact in the PRF Reporting Portal.
- Incomplete Targeted Distribution payments – the organization’s parent entity completed all General Distribution payments, but a Targeted Distribution(s) was not reported on by the subsidiary.
While attesting to an extenuating circumstance is required, no supporting document or proof is required. More information and a step-by-step guide from the AMA are available here.
If HRSA approves the extenuated circumstances form, the provider will receive a notification to proceed with completing the Reporting Period 1 report shortly thereafter. Providers will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal. The AMA will continue to advocate for greater flexibility and more information to ensure physician practices have an adequate opportunity to come into compliance.
10 Most Diverse Medical Schools: US News & World Report
As part of its annual best graduate schools lists, U.S. News & World Report worked with the Robert Graham Center, a division of the American Academy of Family Physicians, to rank the most diverse medical schools.
The rankings, released March 29, are based on fall 2021 medical and osteopathic school-level race and ethnicity enrollment information reported to U.S. News in fall 2021 and early 2022 by the schools. The rankings include 126 medical and osteopathic schools and consider the percentage of each medical school’s fall 2021 total enrollment who are underrepresented minority students and how that percentage compares with state and national race-ethnic-group proportions. Access more information about the methodology here.
Note: The list includes ties.
- Howard University College of Medicine (Washington, D.C.)
- Herbert Wertheim College of Medicine at Florida International University (Miami)
- The UC Davis School of Medicine (Sacramento, Calif.)
- The Robert Larner College of Medicine at the University of Vermont (Burlington)
- University of New Mexico School of Medicine (Albuquerque)
- Kaiser Permanente Bernard J. Tyson School of Medicine (Pasadena, Calif.)
- Lewis Katz School of Medicine at Temple University (Philadelphia)
- University of Miami Leonard M. Miller School of Medicine (Miami)
- Brody School of Medicine at East Carolina University (Greenville, N.C.)
- Pritzker School of Medicine at University of Chicago
–Gooch, Becker’s Hospital Review
MSSNY Supporting Copay Accumulator Legislation
The Senate Insurance Committee will vote on legislation at its next meeting on Monday, April 25th to prohibit insurers from preventing patients from using a copay card or coupon to count towards their insurance deductibles through a relatively new insurance benefit design known as “Copay Accumulators”.
Many patients rely on financial assistance programs, such as a copay coupon or card, to reduce the cost of their medication. But insurers are employing a new tactic — called a copay accumulator adjustment — to undermine these financial assistance programs. Copay Accumulators prevent patients from using a copay card or coupon to cover their out-of-pocket expenses. Under this practice, when a patient uses a copay coupon or card, the health plan receives the payment from the card or coupon, yet the amount of the support provided by the coupon/card does not count towards the patient’s maximum out-of-pocket limit. This legislation would ensure these payments benefit the patient rather than insurers.
Despite New York State’s strong record in providing affordable access to health insurance, many New Yorkers still struggle to pay for their prescription drugs and for those battling chronic illnesses like cancer, diabetes, multiple sclerosis, and others, the burden is often overwhelming.
Patients taking medications to help recover from illness or to manage life-threatening and chronic medical conditions often face significant out-of-pocket cost-sharing requirements such as high deductibles, health insurer-imposed Copay Accumulators have a significant adverse affect upon patients living with chronic conditions like cancer, diabetes, Multiple Sclerosis, and a host of others.
MSSNY strongly supports policy to ensure that third party financial support will help patients to meet the cost of their medications. Please take a minute to visit our Grassroots Action Center (GAC) to take action let your legislators know that you support passage of this important legislation!
Biosimilars Awareness and Patient Access Assessment
Patients living with chronic or complex diseases have benefited in recent years from innovative biological medicines, which are manufactured from living cells and highly effective for many patients. Today, there are even more options on the market with so-called Biosimilars, which are biological medicines approved by the Food & Drug Administration (FDA) as “highly similar” to an original biologic therapy.
Like many states, New York enacted a law that permits a pharmacist to substitute an FDA-approved biosimilar for an original biologic therapy, provided there is notice to the prescribing physician within 5 days of the substitution. With that law expiring in 2022, and the State Legislature likely to consider an extension or changes to that law, there is a great need for MSSNY to learn about physicians’ experiences with the application of this law, as well as their experiences regarding health insurers’ similar or disparate coverage of innovator and biosimilar therapies.
To help us better understand this growing area of medicine from your perspective as physicians, we need your help and less than 5 minutes of your time by taking this very brief survey today.
MSSNYPAC at the HOD
MSSNYPAC Chairs Dr. Thomas Lee and Dr. Rose Berkun invite local physicians, medical students, delegates, and guests who will be attending the MSSNY House of Delegates or in the Tarrytown area on Friday, May 20 to attend the MSSNYPAC membership meeting at the Tarrytown Marriot. We will discuss the recent legislative accomplishments, legislative priorities for the remainder of the 2022 Legislative Session and the essential role MSSNYPAC plays in supporting physician relationships with candidates seeking election or re-election the NYS Senate, NYS Assembly and statewide offices. Contact Jennifer Wilks at email@example.com or call/text 914-933-7722 for further information or to RSVP. Donate online today at www.mssnypac.org.
Join Healthcare Appreciation Week at Yankee Stadium
Baseball season is off and running! Healthcare Appreciation Day at Yankee Stadium will be held the week of May 6th– May 11th. Healthcare workers and their families may take advantage of a special offer for these nights that includes 20-45% discounted tickets, a commemorative scrub top, as well as a complimentary hot dog and drink. Purchase tickets.
CDC Issues Health Advisory About Cluster of Children with Hepatitis
The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network (HAN) Health Advisory notifying clinicians about a recently identified cluster of children with hepatitis and adenovirus infection.
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