MSSNY eNews: January 21, 2022 – Gov’s Budget: What Physicians Need to Know

Gov’s Budget: What Physicians Need to Know

Colleagues:

I was encouraged this week by Governor Hochul’s proposed Budget, which contains several initiatives that will benefit our patients and our fellow health care workers as we approach the beginning of the third year of the COVID-19 pandemic.  The Governor invests in the future of patient medical care delivery by providing significant increases to the Doctors Across New York loan repayment program and invests in care accessibility by ensuring fair payment for patient care delivered via telehealth.  Additionally, it includes the restoration of last year’s 1.5 percent cut and a 1% across the board increase for Medicaid payments; an increase in Essential Plan eligibility; and elimination of CHIP insurance payments for patients in families earning less than 233 percent FPL.

But unfortunately, the proposed Budget is not its without challenges for the physicians of New York. While the proposal to significantly reduce interest rates on court judgments would help to bring down New York’s exorbitant medical liability insurance costs, we are very concerned with another proposal that would thrust potentially significant new costs on countless physicians in the State who are enrolled in a long-standing program to provide supplemental insurance coverage to help offset New York’s notoriously high medical liability costs. We are also concerned with proposals that have the potential to create more silos in health care delivery instead of physician-led team care.

MSSNY is continuing to review various facets of the proposed Budget that would impact patient access to primary and specialty physician care. We look forward to working with the Governor and Legislature to ensure the final Budget due April 1 will continue to ensure patient access to the physician of their choice.

Joseph Sellers, MD, FAAP
MSSNY President

MSSNY Podcast – MSSNY Update 1-21-2022: A Closer Look at the Executive Budget and How it Impacts NY’s Physicians
Listen to MSSNY’s January 21^th podcast with Senior Vice-President & Chief Legislative Counsel Moe Auster as he breaks down this week’s Executive Budget and its Impact on New York Physicians.  

Join us for MSSNY’s Virtual Lobby Day on March 8^th
The $216 Billion dollar budget proposed by Governor Hochul this week will have a profound impact on all New York physicians. At times like these, it is more important than ever that leaders in Albany listen to the concerns of physicians. To make their voices heard, physicians should plan to attend MSSNY’s Virtual Lobby Day on Tuesday, March 8^th. Register Now!

The format will follow last year’s format, 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).

In her budget, Governor Hochul articulated support for a number of measures advocated by MSSNY such as: support for telehealth payment parity, significant increases in loan repayment programs for physicians, and increased eligibility for subsidized health insurance coverage for patients. However, she also indicated support for measures where physicians have raised strong concerns, such as eliminating statutory collaborative agreement requirements for nurse practitioners to practice in collaboration with a physician and potentially significant new costs for Excess Medical Liability Insurance coverage.

There are countless other items that will be under discussion this legislative session as well, including further proposals to change scope of practice of various non-physician practitioners, proposals to reduce health insurer prior authorization hassles, and proposals to address various public health threats. We urge all physicians to join their colleagues in advocacy to their legislators to protect access to quality care for their patients.

Governor’s Executive Budget Brings Important Investments in Health Care But Some Items of Concern as Well
Governor Hochul’s proposed Budget for FY 2022-23 includes significant investments in New York’s health care system and its health care workers, weary from multiple years of responding to the COVID crisis. MSSNY looks forward to working with the Governor and Legislature as they negotiate the details for the final budget. The following highlights MSSNY’s position on a range of these funding proposals. 

MSSNY Supports

• Requiring health insurers to pay physicians for Telehealth Services at the same levels as traditional services
• Increasing from $9M to $15M funding for the Doctors Across New York Program to provide loan forgiveness for physicians who agree to work in underserved areas for three years
• Expanding funding for the SUNY Pre-Medical Opportunity Program and the Diversity in Medicine Program, which recruits and trains a diverse healthcare workforce to represent the diversity of the patients in underserved communities.
• Coverage Expansion and Patient Access Protection
• Restore last year’s 1.5% cut & a 1% increase across the board for Medicaid payments
• Expand Medicaid coverage for postpartum care for up to one year after birth
• Expand eligibility for New York’s Essential Plan to persons with incomes up to 250% FPL
• Eliminate premiums for CHIP coverage for children in families with less than 222% FPL
• Creation of a new Pharmacy Benefits Bureau to license and regulate PBM practices
• Continue funding for the Committee for Physician Health (CPH) at the historical level of $990,000
• Giving DFS power to enforce violations of some federal health insurance protections and protect against some excessive medical record requests.
• Requiring a 60-day deadline for all New York regulated health plans to review physician credentialing applications
• Reduce statutory interest rates on judgments from 9% to a market rate

MSSNY Opposes

• While the proposed budget once again includes $102 million for the state’s Excess Malpractice Insurance Program, it would radically restructure the program by requiring physicians to purchase the coverage themselves, and then be reimbursed in two yearly installment payments. This could thrust tens of thousands of dollars in new costs on many physician practices still trying to recover from the pandemic
• Elimination of the statutory requirement for primary care nurse practitioners to practice in collaboration with a physician
• Allowing pharmacists to perform limited services lab tests authorized by FDA.\
• Elimination of “prescriber prevails” protections in Medicaid and Medicaid managed care

Other Proposals of Note/Under Review

• Conform New York’s “Surprise Billing” law to new federal law protections (many of these provisions were synthesized into New York law through previous DFS Circular letters). This would eliminate the requirement that a physician obtain an Assignment of Benefits from a patient to proceed to an Independent Dispute Resolution (IDR). However, it would also expressly permit an IDR entity’s consideration of insurer median payments even though not required by the federal law
• Adding New York to the list of states who have joined the Interstate Medical Licensure Compact. Currently, 30 states belong to the Compact
• Transfers to DOH oversight of all Education Law regulated health care providers.
• Updating the definition of “emergency medical services” to include community paramedicine, which permits EMTs to provide some non-emergency health care services
• $1.2 billion in bonuses for health care workers making less than $100,000 in Article 28 facilities and certain non-Article 28 locations
• $1.6 billion in capital funding for health care facilities

This is a preliminary list. Please remain alert for further updates as MSSNY staff continues to pore through the thousands of pages of Budget bills.

MSSNY Supports Legislation Banning Use of “Fail First”/ “Step Therapy” Policies on Treatments for Mental Health Conditions
This week the Assembly Insurance Committee reported to the floor a bill (A.3276, Gunther- D/Middletown, S.5909/Kaminsky- D, Rockville Centre) that will prohibit insurers from applying “fail-first” (also known as “step therapy”) protocols to coverage for the diagnosis and treatment of mental health conditions. MSSNY supports this legislation. The bill passed the Senate in 2021 but did not advance from the Assembly Insurance Committee.

“Fail-first” or “step therapy” policies require patients to try a less costly treatment chosen by their health plan, rather than the medication originally prescribed by their provider, and to “fail first” before the plan will cover the treatment originally prescribed by the physician. This often leads to patients taking medications that they have tried previously, without success, that often lead to adverse side effects and other complications. Moreover, there is evidence that these policies increase total utilization costs because of increased inpatient admissions, emergency department visits, and other care needed as a result of not having access to the most effective treatment from the start.  The Legislature enacted an important law in 2016 supported by MSSNY and many other patient advocacy groups to provide defined criteria for the circumstances for when a physician can successfully override an insurer-imposed step therapy protocol, but it still can be very difficult to override these protocols. This legislation would provide greater protection so that a patient can receive the medication that has been recommended by their physician. Please remain alert for further updates on this issue.

Senate Health Committee Reports Bill to Establish Payment Parity for Telehealth Services
For several years, the Veterans Mental Health Training Initiative (VMHTI) was funded through a legislative add-on to provide skills, development, and education to those working in the mental health field with service members and their families. This initiative is a partnership between the Medical Society of the State of New York, The New York State Psychiatric Association, and the National Association of Social Workers-New York State.

These associations work to deliver free training to service providers across New York. They also work with counties implementing the NYS Joseph P. Dwyer Veterans Peer Support programs, which provide holistic care for returning veterans. Through this initiative, MSSNY has been able to provide seminars, webinars, and other online programming to MSSNY’s county medical societies and hospitals. MSSNY is asking physicians to send a letter on the VMHTI through its Grassroots Action Center (GAC) https://p2a.co/55LVw82 to ensure that this funding is included in the state budget.

MSSNY Seeks NYS Funding for the Veterans Mental Health Training Initiative
For several years, the Veterans Mental Health Training Initiative (VMHTI) was funded through a legislative add-on to provide skills, development, and education to those working in the mental health field with service members and their families. This initiative is a partnership between the Medical Society of the State of New York, The New York State Psychiatric Association, and the National Association of Social Workers-New York State.

These associations work to deliver free training to service providers across New York. They also work with counties implementing the NYS Joseph P. Dwyer Veterans Peer Support programs, which provide holistic care for returning veterans. Through this initiative, MSSNY has been able to provide seminars, webinars, and other online programming to MSSNY’s county medical societies and hospitals. MSSNY is asking physicians to send a letter on the VMHTI through its Grassroots Action Center (GAC) https://p2a.co/55LVw82 to ensure that this funding is included in the state budget.

Peer to Peer (P2P) Program
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. 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.

Watch here, to see Frank Dowling, MD and Charles Rothberg, MD give an interview on MSSNY’s P2P program.

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

Email: P2P@mssny.org and request that you be connected with a peer supporter

Phone: 1-844-P2P-PEER (1-844-727-7337) and request that you be connected with a peer supporter

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

The Impact of the COVID-19 Pandemic on Racial and Ethnic Minorities
Registration Now Open – February 16, 2022 @ 7:30am
The COVID-19 pandemic has cast a spotlight on health inequities that lead to inequitable health outcomes amongst racial and ethnic minorities. Learn more about the impact of the COVID-19 pandemic on racial and ethnic minorities by registering for “The Impact of the COVID-19 Pandemic on Racial and Ethnic Minorities” on Wednesday, February 16, 2022, at 7:30 A.M. Yvette Calderon, MD, MS will serve as faculty for this program. Register now.

Educational objectives are:

• Outline some social determinants of health that put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19
• Identify the ways in which racial and ethnic minority groups have been disproportionately impacted by the COVID-19 pandemic
• Describe strategies to improve COVID-related health outcomes for racial and ethnic minorities

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.                                    

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

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