MSSNY eNews: March 25, 2022
Message from MSSNY President Dr. Joseph Sellers:
Telehealth is Here to Stay
This week’s AMA telehealth survey makes it clear what I think most of us already know: telehealth works for both patients and physicians—and telehealth is here to stay.
Nearly 85% of physician respondents indicated they are currently using telehealth to care for patients, and nearly 70% report their organization is motivated to continue using telehealth in their practice. More than 80% of physician respondents indicated that their patients have had better access to care since using telehealth. Many physicians foresee providing telehealth services for chronic disease management and ongoing medical management, care coordination, mental/behavioral health, and specialty care.
But key to continuing to have this modality available for our patients is getting insurance companies to pay fairly for care provided via telehealth. As Governor Hochul and the state legislature move into the final days of negotiations for the FY 2022-23 budget, MSSNY will continue to encourage lawmakers at the Capitol to pass policy that requires insurers to pay physicians for telehealth on par with what they’re paid for an in-person visit when providing the same care.
We are reaching out on several other fronts as well. Last week, we released a joint statement to the press from New York physician and hospital organizations calling on the Legislature to include telehealth payment parity in the final enacted budget. In an interview I did with WRGB-TV/CBS Albany, I said that telemedicine has been the one positive to come out of the pandemic; it gives us the ability to meet patients where they are and to help people who are home bound or live in rural areas. I have interviews scheduled with several other media outlets next week as well.
In addition, we are continuing to amplify the issue on our social media platforms and through our grassroots network. I encourage you to engage with our tweets on this issue and to reach out to your Assembly member and state Senator and urge them to speak to their leadership to support inclusion of payment parity for Telehealth services. Support Payment Parity for Telehealth Services.
Joseph Sellers, MD, FAAP
Legislature, Governor Negotiating State Budget
As the New York State Senate and State Assembly work around the clock in negotiations with Governor Hochul to achieve adoption of a State Budget by the State deadline of April 1, physicians should be aware of the number of proposals under discussion that could impact physicians and the patients they treat.
Telehealth Payment Parity. Both the Executive Budget proposal and the Senate’s Budget proposal included language supported by MSSNY to require health insurers to pay telehealth services at levels equal to in-person services. The Assembly did not include this provision in their one-House Budget, but negotiations are ongoing. Physicians can send a letter in support here: Support Payment Parity for Telehealth Services (p2a.co)
Public Health Investments. Importantly, both one-House Budget proposals agreed with the Executive Budget proposal to significantly increase funding for the Doctors Across New York student loan repayment program, and to implement a 1% across the Board Medicaid payment increase.
Both Houses also agreed with various initiatives to increase and maintain access to comprehensive health insurance, including increasing the upper income threshold eligibility for the State’s Essential Plan health insurance program, and eliminating premium requirements for eligibility for the CHIP program for families less than 223% FPL.
Excess Medical Malpractice Insurance Program. One-House Budget proposals did not include a proposal that would require the insurance carriers writing Excess Liability coverage be paid in two annual installments. However, discussions with the Executive have been ongoing regarding using possible unused allocations from previous Budgets to provide a full allocation for the 2022-23 policy year and ensuring that there be no physician cost-share responsibility.
Scope of Practice Proposals. Both one-House Budget proposals did not include language opposed by MSSNY that would create further silos in healthcare by permitting pharmacists to perform numerous lab tests without physician coordination and eliminating current statutory requirements for nurse practitioners (NPs) to maintain collaborative relationship with physicians.
The Assembly Budget proposal would permanently extend the existing law that requires NPs with more than 3,600 hours experience to comply with simplified collaboration standards that do not require a written practice agreement but ensure there are defined collaborative relationships with a physician practicing in the same specialty as the NP. The Senate indicated that “each scope of practice deserves a robust conversation outside the context of the Executive Budget”
Physicians can send a letter in support of protecting physician-led team care here: Protect Physician-Led Team-Based Care (p2a.co)
Licensing/Oversight Proposals. Both Houses did not include a proposal to transfer oversight of the several health professions from the Department of Education to the Department of Health.
The Assembly did not include a proposal to permit New York to join the Interstate Medical Licensure Compact. The Senate included the proposal in its one-house Budget.
Surprise Bill Law Changes. Both one-House Budget proposals did not include language contained within the Governor’s Budget to make changes to New York’s surprise bill law to ensure it meets the requirements of the federal No Surprises Act (NSA) recently passed by Congress. Most of these changes have been implemented through Circular letters issued last December by the NY Department of Financial Services. While MSSNY did not object to formalizing these necessary changes to statute that had been advanced in the Executive Budget, it did oppose one aspect of that proposal – not required by the NSA – that would require the Independent Dispute Resolution entity to consider the insurer’s self-determined median in-network payment amounts.
MSSNY Continues to Urge Governor Hochul to Stop Changes to the NYS Empire Plan
MSSNY continues to be in regular communication with the Governor’s office to express its deep concerns with the position taken by the NY Department of Civil Service (DCS) that claims that NYSHIP/Empire Plan is no longer subject to NY insurance law regulations when the Empire Plan reimburses out-of-network physicians for medically necessary services, including the State IDR process for resolving disputes. MSSNY has also been in discussion with hospital associations that would likely also be adversely affected by this decision by DCS, as well as law firms representing physicians impacted by this.
As noted in last week’s e-news, MSSNY has together with the NYS Society of Anesthesiologists and NYS Society of Plastic Surgeons written to the Governor’s to staff to argue that these actions by the NYSHIP/Empire Plan are contrary to the provisions of the Civil Service Law, which requires that the Empire Plan be subject to NY insurance laws and DFS regulation. If not addressed, not only may physician practices suffer long-term irreparable harm, but it could also harm patients, who will see the availability of high-quality medical services significantly reduced, particularly given that a major selling point of public employment in New York has been the Empire Plan’s out-of-network benefit.
MSSNY Seeks NYS Funding for the Veterans Mental Health Training Initiative
MSSNY staff and leadership continue to advocate for funding the Veterans Mental Health Training Initiative (VMHTI) within the NYS budget. Since 2008, this program had been funded through a legislative add-on to provide skills, development, and education for primary care physicians and other mental health providers to treat veterans within their practice. 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 send a letter on the VMHTI through its Grassroots Action Center (GAC) to ensure that this funding is included in the state budget.
Governor Hochul Recognizes 12th Anniversary of the Affordable Care Act & Celebrates Gains in Insurance Coverage
This week, Governor Hochul recognized the 12th anniversary of the Affordable Care Act and the historic levels of health insurance coverage through New York State of Health, the state’s official health plan marketplace, which has provided over 6.5 million New Yorkers access to affordable health insurance. Governor Hochul Statement | Governor Kathy Hochul (ny.gov)
Flexibilities resulting from the COVID-19 Public Health Emergency, as well as enhanced federal tax credits made available under the American Rescue Plan Act of 2021, have made coverage through the marketplace more affordable for many New Yorkers. For example, enhanced tax credits saved eligible New Yorkers an average of $100 per month on Qualified Health Plan (QHP) premium costs in 2021.
However, as noted in the Governor’s statement, if Congress does not extend these subsidies beyond 2022, QHP consumers could see their monthly premiums rise by 58%. Governor Hochul is calling on Congress to extend these tax credits to preserve critical health insurance coverage for New Yorkers. MSSNY also recently urged its Congressional delegation members to support continuation of these additional subsidies.
For more information about Marketplace health plans and enrolling in coverage, visit: nystateofhealth.ny.gov
Consumers continue to have a choice of health plan options and can use the NYS Provider & Health Plan Look-Up Tool to search for preferred provider networks, including doctors and hospitals. Free enrollment assistance is provided in local communities throughout the state.
- Consumers can enroll in a health plan by:
- Calling the Customer Service Center at 1-855-355-5777
- Monday to Friday, from 8:00 a.m. – 8:00 p.m.
- Saturdays, from 9:00 a.m. – 1:00 p.m.
- Logging onto the website at ny.gov
- Speaking with an enrollment assistor. Find an assistor here.
PAI Submits Prior Auth Simplification Recommendations to HHS
The Physicians Advocacy Institute (PAI) this week submitted comments to the US Department of Health & Human Services (HHS) in response to a January Request for Information (RFI) from HHS regarding electronic prior authorization (PA) standards. MSSNY is one of the 10 state medical associations represented on the Board of the PAI.
The letter highlighted the excessive hassles physician experience with PAs due to “payors’ complex and sometimes conflicting rules for coverage and payment” and that the “lack of uniform regulatory standards has allowed health plans to adopt PA policies that reflect inconsistent policies and processes, making it exceedingly difficult for physicians to navigate as they seek to deliver clinically indicated care to their patients.”
Specifically, the PAI recommendations for addressing PA hassles included:
- Streamlining the PA process and ensure that payers provide transparent and timely PA decisions for medical services and medications, including:
- Clearly identifying all missing and/or necessary documentation at the onset of denying a prior authorization.
- Allowing any additional documentation required for prior authorization to be sent electronically, not just via paper/fax.
- Providing notice of PA decisions no later than 24 hours after receiving a request for expedited, urgent decisions and no later than 3 calendar days for standard decisions.
- Adopting streamlined electronic PA processes based on national, clinical standards that promote greater transparency to allow physicians to understand the clinical bases for PA determinations.
- Require health IT developers to develop and deploy software and processes that facilitate PA automation using standard electronic transactions as well as construct user friendly modules/tutorials for physicians transitioning from manual to electronic PA.
- Collect data on the electronic PA system, including the list of services requiring prior authorization, the percent approved, percent denied or denied and later approved, and the length of time it takes to get final approval.
MSSNY continues to pursue legislation in New York State to reduce PA hassles, including legislation (S.8299, Breslin) to create a process where physicians who are regularly approved for their PAs can be exempted by health plans from the process, and legislation (A.7129/S.6435) to eliminate the need to obtain repeat prior authorizations after initial approval. Physicians can send a letter in support here: Prior Authorizations (p2a.co)
NYS DOH to Conduct Webinar on Enrolling as a Provider for COVID-19 Vaccine on March 31, 2022
If your practice services pediatric patients and you are not yet enrolled in the NYSDOH COVID-19 Vaccination Program, please join the New York State Department of Health for a one-hour question and answer webinar at 12-1 p.m. on Thursday, March 31, 2022. This webinar is for New York State practices that are located outside of New York City.
COVID vaccine is currently available for children ages 5 and up, and boosters are authorized from those 12 years and older. Vaccines for children ages 6 months to under 5 years old are in clinical trials and are anticipated to be authorized soon. Vaccines are the best way to end the COVID-19 pandemic, and DOH wants to assist you in enrolling in the program!
Please note Vaccines for Children (VFC) providers who want to receive and administer COVID-19 vaccine must also complete the COVID-19 Vaccination Program enrollment process. VFC providers are not automatically enrolled for the COVID-19 Vaccination Program.
Please use the following link to join the webinar: Events
Next Week: CMS-1500 Q&A Webinar for Health Care Providers
Just a reminder the Workers’ Compensation Board’s (Board’s) CMS-1500 Q&A webinar series for health care providers starts next week.
If you haven’t shared your questions yet, please do so by taking this brief survey.
Each one-hour session will begin with a brief overview of CMS-1500, including payer objections to bills and how and when to file a dispute for non-payment of a bill, followed by several of the most frequently asked questions. We will leave time at the end for any additional questions you may have.
Medical Matters CME Webinar: Stresses & Distresses in the Time of COVID-19
The COVID-19 pandemic has caused innumerable mental health sequelae that will likely be present for years to come. Register now for Stresses & Distresses in the Time of COVID-19 on Wednesday April 20, 2022, at 7:30 a.m. to learn more about the stresses and distresses the COVID pandemic has caused. Craig Katz, MD, vice-chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Register now.
Educational objectives are:
- Illustrate the many sources of stress that society is enduring in recent years
- Identify the many ways different ways the resulting distress can be experienced
- Discuss what clinical approaches are available for helping
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at firstname.lastname@example.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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