MSSNY eNews January 7, 2022 – Federal No Surprises Act Is in Effect: Are You Ready?
Good News from Albany
While many New Yorkers were busy celebrating the holidays over the last few weeks, many things were happening in the health care arena that will impact both physicians and our patients.
Governor Hochul signed a few important bills in the waning days of 2021, including legislation that will provide greater accountability and transparency of the practices of PBMs, require PBMs to 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. Another significant bill signed by the Governor limits the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year.
And the Surprise Bills Act (NSA) took effect on January 1, 2022. Every physician—whether in-network or out-of-network—will have to comply with the NSA by providing a form to patients outlining their rights. The AMA has developed a toolkit to assist physicians in implementation of various aspects of the NSA, which prohibits out-of-network health care providers and facilities from balance billing commercially insured patients in certain circumstances.
During Wednesday’s State of the State Address, Governor Hochul highlighted several important and positive initiatives related to health care, including incentives to train and keep physicians and other critically needed health care providers in New York State, expanded availability of affordable health insurance coverage for our patients, and expanding the delivery of care and fair payment for telehealth. However, the Governor also raised some potentially concerning proposals to change scope of practice for some non-physicians.
As we head into this new legislative session with ever-changing priorities and challenges before us, I urge my colleagues to set aside Tuesday, March 8 to participate in MSSNY’s virtual Physician Advocacy Day. Register here.
I have every confidence that when we as a profession take the time to be actively engaged in policy discussions that impact the care to our patients, the results—far more often than not—are successful.
I wish every MSSNY member a happy, healthy, and prosperous 2022.
Joseph Sellers, MD, FAAP
Join us for MSSNY’s Virtual Lobby Day on March 8th
In her State of the State address this week, Governor Hochul put forth a legislative agenda that would have profound impact on all New York physicians. To make their voices heard, physicians should plan to attend MSSNY’s Virtual Lobby Day on Tuesday, March 8th. To register, click here: Physician Advocacy Registration
The format will follow previous years formats, 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).
As noted below, Governor Hochul’s State of the State message this week highlighted a number of measures supported 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, it also notes her 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.
There are countless other items that will be under discussion this legislative session as well, including proposals to reduce health insurer prior authorization hassles, further proposals to change the scope of practice of non-physician practitioners, 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. (BARTLETT)
Governor Identifies Legislative Priorities in State of State Message:
This week, Governor Kathy Hochul presented her legislative priorities for the year in her first State of the State Address. As outlined in her briefing book, among the most notable positive items relating to health care include:
- Require health insurers to reimburse Telehealth Services at the same levels as traditional Services
- Increase funding for the Doctors Across New York Program to provide loan forgiveness up to $120,000 for physicians who work in underserved areas for 3 years.
- Expand the SUNY Pre-Medical Opportunity Program and the Diversity in Medicine Program which recruits and trains a diverse healthcare workforce that represents the diversity of patients in underserved communities
- Expand from 200% FPL to 250% FPL eligibility for New York’s Essential Plan coverage for those who make too much to qualify for Medicaid.
- Eliminate premiums for CHIP coverage for children in families between 160-222% FPL
- Expand Medicaid coverage for post-partum care for one year after birth
Some concerning items included:
- Eliminating remaining statutory requirements for nurse practitioners to practice in collaboration with a physician
- Joining the Interstate Medical Licensure Compact to permit out of state physicians to be licensed in New York and New York physicians to be licensed in other states expeditiously
Many of these items will be included within the Executive Budget that will be presented by Governor Hochul on or about January 18th.
(DIVISION OF GOVERNMENTAL AFFAIRS)
MSSNY Supports COVID-19 Immunizations for Healthcare Workers and Children
The Medical Society of the State of New York this week released a statement in response to an anti-vaccine rally held at the State Capital on the first day of the NYS Legislative Session. MSSNY continues to strongly support the requirement for COVID-19 immunization of all healthcare workers. MSSNY also supports requiring immunization of school age children. A copy of the statement can be found here.
Children’s Health Defense New York, led by anti-vaccine founder Robert F. Kennedy, Jr., has organized and funded a group called The People’s Coalition for New York. Children’s Health Defense New York provided funding for buses for the groups involved in the rally. The group is
opposed to various legislative measures that would improve public health. MSSNY will continue to aggressively promote the importance of being vaccinated and boosted against Covid-19 and to counter the group’s messaging that threatens our public health. (CLANCY)
Go to MSSNY Webpage for More Information on No Surprises Act Implementation
The implementation of the federal No Surprises Act (NSA) on January 1, 2022 means that physicians must familiarize themselves with the many aspects of this law that will impact the care they provide to patients both when they are out of network and in-network.
For more information on these new requirements, physicians can go to the following page on the MSSNY website: Preparing for the No Surprises Act – (mssnyenews.org) where they can find:
- AMA toolkit for physicians: Preparing for implementation of the No Surprises Act (ama-assn.org) developed by the American Medical Association
- Several guidance letters prepared by the New York Department of Financial Services regarding integrating these NSA provisions into New York State’s law
- The model notice all physicians, hospitals, and other health care providers will need to provide to their patients, in their office and posted on their website, regarding patient protections against surprise billing.
Physicians are also reminded that MSSNY’s General Counsel, the Garfunkel Wild law firm, has developed a webinar on February 1 at noon to discuss what health care providers need to know.
GW Complimentary Webinar – February 1, 2022 – Federal No Surprises Act – One month in. What have we learned? What questions remain? | Garfunkel Wild. (AUSTER)
Governor Hochul Signs Bills to Increase PBM Transparency & Limit Insurers’ Ability to Make Mid-year Formulary Changes
Governor Hochul signed two bills into law in late December that are critical to helping patients access the medications they need and to ensure greater oversight of pharmacy benefit formulary development practices. MSSNY thanks the many physicians who took the time to send letters to Governor Hochul in support of these bills over the last several months.
- The first bill (1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices ofPharmacy Benefit Managers (PBMs). The bill requires that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. MSSNY has supported greater oversight and regulation of PBMs as one way to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications. The law takes effect on or about March 31, 2022.
- The second bill, (A.4668, People-Stokes/S.4111, Breslin), will significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. To address concerns raised in a veto message from 2019, the new law will prohibit 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. Based upon a chapter amendment negotiated by Governor Hochul with the State Legislature, the provisions will take effect for policies beginning
January 1, 2023. (CARY, AUSTER)
Please Urge Your Legislators to Protect Physician-Led Team Care
With a new Legislative Session beginning this week, physicians are again reminded to contact their Senators and Assemblymembers to oppose legislation (S.3056-A/A.1535-A) that could lead to uncoordinated, siloed care by eliminating any statutory requirements for nurse practitioners to maintain collaborative arrangements with a physician practicing in the same specialty. A letter can be sent from here: Protect Physician-Led Team-Based Care for Patients (p2a.co). The legislation would also eliminate the requirement for a newly practicing nurse practitioner to maintain a written collaborative agreement with a physician.
The legislation had advanced to the Senate floor last Session, and Governor Hochul announced her support for this concept as part of her State of the State briefing book this week. As part of last year’s State Budget, there was a provision enacted that extended until June 30, 2022 the existing law that permits nurse practitioners with more than 3,600 hours of experience to practice without a written collaborative agreement provided they maintain evidence of “collaborative relationships” with a physician in the same specialty practiced by the NP.
In an Assembly public hearing this past November, and in communication with the Governor’s office, MSSNY raised concerns that the crisis standard of care that led to the waiving of these very important patient protections during the height of the pandemic should not become the general
standard of care. These communications highlighted a recent MSSNY survey in which 75% of the physician respondents to this survey indicated that advanced care practitioners working independently during the pandemic under the Governor’s Executive Orders (waiving physician
supervision requirements) had committed an error while treating a patient and 90% indicated that the error could have been prevented had there been physician oversight. (AUSTER)
NYS Department of Financial Services (DFS) Makes Audio-Only Telehealth Coverage Policy Permanent
After ongoing, temporary emergency regulations from DFS, the department has made permanent the policy that requires private commercial insurance plans to cover Telehealth services delivered via audio-only. An insurer may still engage in reasonable fraud, waste, and abuse detection efforts, including to prevent payments for services that do not warrant separate reimbursement.
The new policy was adopted to mitigate health and safety risks during the ongoing pandemic and because Telehealth has proven to be an effective tool in providing quality care for patients around the state. To view the permanent regulation: https://www.dfs.ny.gov/system/files/documents/2021/12/rfin_adopt_reg62_amend62_text.pdf
Additionally, it is important to note that a statute was enacted in 2020 that requires Medicaid to cover audio-only Telehealth services. (CARY)
The Telehealth Initiative
Through the Telehealth Initiative, MSSNY and the AMA will work together to develop relevant educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation. Through the program, MSSNY will be part of a national network and will offer support to 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 all together. 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, expert mentoring to discuss optimization and sustaining telehealth into practice, and virtual events/discussions which provides a network for physicians and care teams to share experiences will be provided to all participants.
Are you interested in learning more about joining the Telehealth Initiative? Join us for a Town Hall call on Tuesday, January 11th at 5:30pm ET to hear more about the program, how to get involved, and what to expect. Leaders from across the participating associations and organizations will also be available for questions! We look forward to seeing you there!
Click here to join the meeting
If you or someone you know is interested in joining this initiative, please reach out to Cayla Lauder, MPH, Program Coordinator at email@example.com. (LAUDER)
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.
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 or by Phone: 1-844-P2P-PEER (1-844-727-7337). 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 firstname.lastname@example.org. (LAUDER)
Registration Now Open – January 19, 2022 @ 7:30am
Medical & Veterans Matters CME Webinar
Military Involvement in COVID Response & the Impact of COVID-19 on Veterans
The Department of Defense has contributed widely to COVID response throughout the pandemic, and COVID has had significant impacts on veteran populations. Learn more about military involvement in the response to the COVID-19 pandemic as well as the impact the COVID pandemic has had on the veteran population by registering for “Military Involvement in COVID Response & the Impact of COVID-19 on Veterans” on Wednesday January 19, 2022 at 7:30 a.m. Frank Dowling, MD, MSSNY Secretary and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.
Educational objectives are:
- Identify the wide ranging medical and mental health impact of COVID on veterans
- Discuss post-traumatic growth of veterans who have experienced COVID related post-traumatic stress
- Recognize the role of physicians in assessing the impact of the pandemic in veteran patients
- Outline the role played by the Department of Defense in responding to the COVID-19 pandemic
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
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. (HOFFMAN)
MSSNY Podcasts Had a Great Year
If you haven’t had the chance to catch up with MSSNY’s podcast offerings, be sure to check them out. Besides frequently published MSSNY Legislative Updates, there are podcasts on the COVID pandemic, Emergency Preparedness, and myriad other topics of relevance to New Yorkers. Click here to explore the library of MSSNY podcasts. (HOFFMAN)
Federal No Surprises Act Is in Effect: Are You Ready?
On January 1, 2022, a new and complex set of rules enacted by the federal government regarding “surprise bills” went 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 firstname.lastname@example.org.
Additional assistance is available from the AMA, which has developed a toolkit to assist physicians in implementation of various aspects of the NSA.
MSSNY Podcast: Wrap-Up of the State of the State and No Surprises Act Updates
Listen to MSSNY’s January 7 podcast on the No Surprises Act and a wrap-up of the Governor’s State of the State Address.
January 5 Press Statement: MSSNY Looks Forward to Further Discussion with Governor and State Legislature on Health Care Initiatives Outlined in State of the State Address
Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York
“Governor’s Hochul’s State of the State Message and briefing book highlights several important initiatives designed to provide some stability to New York’s extraordinary but beleaguered health care system weary of two years of fighting to save the lives of New Yorkers through the COVID-19 pandemic. These include incentives to train and keep physicians and other critically needed health care providers in New York State, expanded availability of affordable health insurance coverage for our patients, and expanding the delivery of care via telehealth.
“We look forward to further discussion with the Governor and the State Legislature on these and the myriad of other health care proposals the Governor has advanced. Physicians across the State of New York are anxious to ensure that patients can continue to access the quality care they need in a timely manner, and from the physician of their choice.”
Updated CDC COVID Recommendations
On January 4, 2022, the CDC updated the recommendation for receipt of a booster dose of the COVID-19 vaccine following receipt of the Pfizer-BioNTech primary series. CDC now recommends receipt of a booster dose at least five months after completing their Pfizer-BioNTech primary series. This previously recommended interval was at least six months.
On January 3 and 4, 2022, the FDA amended the EUA and CDC updated recommendations such that moderately to severely immunocompromised 5-11 year-olds receive an additional primary dose of vaccine 28 days after their second dose. At this time, only the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended for children ages 5-11.
On January 5, 2022, the CDC endorsed the Advisory Committee on Immunization Practice’s (ACIP) recommended expansion of booster dose eligibility for the Pfizer-BioNTech COVID-19 to individuals ages 12 to 15. CDC now recommends that all adolescents ages 12 to 17 should receive a booster dose five months after their initial Pfizer-BioNtech vaccination series.
Following are updated guidance documents, consent forms, and screening checklists:
- Guidance for The New York State COVID-19 Vaccination Program for 12 Years of Age and Older
- COVID-19Immunization Screening and Consent Form: Individuals 12 years of age or older
- Information for Health Care Professionals about the Screening Checklist for the COVID-19 Vaccine: Individuals 12 years of age or older
- Guidance for the New York State COVID-19 Vaccination Program: Vaccination of Children Ages 5-11
- COVID-19 Immunization Screening and Consent Form
- Information for Health Care Professionals about the Screening Checklist for the COVID-19 VaccineAdministration of Pfizer-BioNTech COVID-19 Vaccine
- COVID-19Immunization Screening and Consent Form: Additional Dose for Moderately to Severely Immunocompromised
- Information for Health Care Professionals about the Screening Checklist for the COVID-19 Vaccine: Additional Dose for Moderately to Severely Immunocompromised
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