MSSNY’s Strong Voice at the AMA Special Meeting
Last week, MSSNY’s American Medical Association (AMA) delegates—under the formidable leadership of our Delegation Chair, Dr. Charles Rothberg—participated in the AMA’s five-day House of Delegates Special Meeting. As one of the four largest state delegations to the AMA, MSSNY plays an important role in the proceedings of the House. In fact, although the HOD was greatly limited due to time constraints—MSSNY still had two resolutions considered at the special meeting.
The first MSSNY resolution, Discrimination Against Physicians in Treatment with Medication for Opioid Use Disorders (MOUD)—which was adopted—affirms “that no physician or medical student should be presumed impaired” solely because of a decision, in collaboration with their treating physician, to receive medication for opioid use disorder.” The author of the resolution, MSSNY delegate Dr. Frank Dowling, explained during the virtual reference committee meeting on Sunday that half of the rehabilitation facilities in the country do not allow medication for opioid use disorder or else “frown against” it. Likewise, physician assistance programs too often refer participants to programs where such medications aren’t available, he said.
The second MSSNY resolution, Addressing Inflammatory and Untruthful Online Ratings, was referred for study. The AMA will take action to urge online review organizations to create internal mechanisms ensuring due process to physicians before the publication of negative reviews.
In addition to MSSNY’s two resolutions, we had good news on the election front. MSSNY’s Dr. Pratistha Koirala was elected to the AMA Board of Trustees (BOT). Dr. Koirala joins two other MSSNY members, Dr. Thomas Madejski and Dr. Willie Underwood, on the BOT. In addition, Dr. Robert Goldberg was re-elected to the AMA Council on Medical Education.
Other important adopted resolutions include seeking greater efforts to diversify the physician workforce; help Resident physicians with financial burdens; protecting public assistance that helps sustain health; and stemming the rising tide of youth suicide. For a summary of all the important work that was accomplished at the meeting, read the AMA’s Highlights from the June 2021 AMA Special Meeting.
I am proud to serve as Vice-Chair of MSSNY’s AMA delegation and proud of the hard work and dedication of our delegates. When the House of Medicine works together, we achieve great things for our patients and our beloved profession.
End of NYS Emergency Declaration Also Means Reinstatement of Physician Supervision and Collaboration Requirements
Governor Cuomo’s announcement this week that he has ended the state of emergency also brings to an end numerous Executive Orders suspending various laws and regulations, including those laws that otherwise require physician supervision and or collaboration requirements for various non-physician health care practitioners. To that end, the New York State Education Department issued the following announcement about the end of these Executive Orders as applicable to various Title 8 professionals:
Please be advised that the COVID-19 Disaster Emergency declared by the Governor, pursuant to Executive Order 202 issued on March 7, 2020, and each successor Executive Order to Executive Order 202 have expired as of June 25, 2021. While the several exceptions and authorizations relevant to the Title VIII statutes and regulations contained within these Executive Orders have now expired, the Department understands the concern regarding the short notice of the expiration of the COVID-19 Disaster Emergency and will take that into consideration in the event of any potential inquiries involving activity that had previously been authorized by Executive Order 202 and its successor Executive Orders at this time. However, Title VIII professionals should exercise due diligence and good faith efforts to return to compliance with all Title VIII statutory and regulatory requirements without delay. The Department is working closely with other New York State agencies and the Governor’s Office to clarify issues relating to the expiration of the Disaster Emergency and the reinstatement of laws and regulations that have been previously modified or suspended during the COVID 19 Disaster Emergency. Please continue to monitor the Department’s website for updated guidance.
Physician Participation Needed in Bureau of Narcotic Enforcement Focus Groups
The NYS Department of Health, Bureau of Narcotic Enforcement is seeking input from users of the Prescription Monitoring Program and has reached out to MSSNY to seek physicians willing to participate in focus groups, which will be held in July. Please see message below and provide Pat Clancy, MSSNY Sr. Vice President of Public Health and Education (firstname.lastname@example.org) with your name, email, and dates and time that you are available. MSSNY will provide that information to BNE by June 30, 2021.
The New York State Department of Health (NYSDOH), Bureau of Narcotic Enforcement (BNE) is working on a project to improve the utility of the Prescription Monitoring Program (PMP) Registry and is seeking input from PMP users. The proposed enhancements to the Registry consist of an updated format for the patient search landing page (Confidential Drug Utilization Report) and a dashboard that will display a summary of key visual indicators to highlight patient risk factors. The proposed indicators include the number of pharmacies and practitioners visited by the patient in the last 30 days, the presence of overlapping benzodiazepine and opioid prescriptions, and the presence of prescribed stimulants.
To develop enhancements that best serve PMP users, BNE is eager to incorporate stakeholder input into the project planning and development process through two types of engagement opportunities: virtual focus group and web-based survey. BNE has benefited from collaborations with New York State-based associations to aid in identifying participants for focus groups, surveys, and other stakeholder engagement efforts. BNE once again is looking to the associations to assist in this recruitment process.
Virtual Focus Group Participation
Focus groups will be comprised of five (5) participants for each session and will be held in July 2021. BNE is seeking assistance from interested professional associations including the Medical Society of the State of New York (MSSNY), to identify 35-40 association members each who would be interested in participating in one of the focus groups. We are requesting that a contact list of interested association members be emailed to BNE at the earliest convenience, however, no later than June 29th,2021. BNE would manage the focus group registration process if MSSNY can provide a contact list of its interested members.
The expected participant commitment includes:
• Participation in a one-hour virtual focus group session conducted on a weeknight during evening hours from July 6 -16 and July 26-27, 2021.
• The focus group will be conducted as a recorded webinar, with the expectation that the participant will sign in 5-10 minutes before start of the program.
• Participants will be asked to engage in open and guided discussion.
• Participants will be provided a description of the focus group findings after BNE completion of analysis.
• Participation in a short evaluation survey to provide feedback on resulting enhancements, six (6) months after their implementation.
In addition to the focus group, BNE is also designing a web-based survey to gather input on a morphine milligram equivalents (MME) calculator that has already been developed and can be accessed via the navigation bar within the PMP Registry. The survey offers an opportunity for feedback from PMP users in a format that will only take 10 minutes. MSSNY’s assistance would benefit the effort by disseminating the survey link broadly to its members. The survey will be available in early July and BNE will provide the link and email language to describe the effort. BNE will also manage all logistics related to survey responses. Participants will be provided a final description of survey findings after BNE completion of analysis.
MSSNY Comments on Expiration of Telehealth Waivers in Crain’s
Gov. Andrew Cuomo announced Wednesday that the state’s disaster emergency designation will expire today—and with it, waivers expanding access to telehealth services could go away too. However, some industry advocates say they can see a way to ensure their continued access.
Since the declaration in March 2020, Cuomo has signed executive orders lifting restrictions on telehealth services, including those related to cost-sharing, the kind of services that can be conducted and who can provide them and where.
Although the cost-sharing waiver ended June 4, insurance coverage for audio-only telehealth services had been extended through July 6. Beyond that, it’s not clear whether such services will continue to be covered, said Moe Auster, vice president of legislative affairs for the Medical Society of the State of New York.
Other restrictions lifted via executive order, such as provider types and location requirements, had been included in the 2022 budget, which passed in April.
Many patients need the broad coverage, advocates say.
“Even prior to the Covid-19 pandemic, it was clear that many parts of the state lacked adequate access to basic health care services,” said Sen. Gustavo Rivera, chair of his chamber’s health committee. He represents a district that includes the Bronx. Telehealth had been an effective and safe tool to ensure that many New Yorkers, especially seniors, immunocompromised individuals, and residents with chronic conditions, could access basic health care services, he said.
Although the Legislature’s regular session ended June 10, the state Department of Financial Services has the power to require health insurers to continue covering audio-only telehealth services, Auster said. However, advocates will continue to work with state lawmakers during next year’s session, he added.
“We want to make sure the laws are updated to ensure this continues and grows,” said Assemblyman Richard Gottfried, chair of his chamber’s health committee. His district includes parts of Manhattan.
“We plan to continue conversations which amplify access to care for our most vulnerable populations,” Rivera said. “We’ve seen the potential of telehealth and must adapt our systems to expand virtual care across the state.”
Should insurance coverage of audio-only access go away, it could deter providers from using that platform, Auster said.
“Physicians have invested in trying to deliver telehealth well,” he said, “but if there’s no adequate payment, we will likely see the stop in investment.”
To protect access to telehealth services, Gottfried and Rivera also introduced payment parity bills in their respective chambers, although they did not pass in this year’s session. The bills sought to ensure that health providers are paid the same rate by insurers for services provided over telehealth as in-person visits.
“If reimbursement parity for Medicaid is not maintained, providers will be impacted,” Gottfried said. “And on the commercial side, there continues to be concern that providers will discontinue offering services via telehealth if they are not adequately reimbursed.” —Shuan Sim, Crain’s Health Pulse, 6/24/21
Please Urge Governor to Sign into Law Two Bills to Assist Patients to Receive Needed Medications
Physicians are urged to contact Governor Cuomo to urge that he sign into law two bills that are critical to helping patients to be able to receive the medications they need as well as to ensure greater oversight over pharmacy benefit formulary development practices. A letter or tweet can be sent from here: Urge Gov. Cuomo to SIGN two RX bills – Regulating PBMs and Restricting Mid-Year Formulary Changes (p2a.co)
The first bill (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of pharmacy Benefit Managers (PBMs). The bill was significantly revised from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in your veto message. The bill would require that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. The bill would also provide for the disclosure of all possible revenue streams and terms and conditions that they place on their networks of pharmacies.MSSNY has supported greater oversight and regulation of PBMs as one manner to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications.
The second bill (A.4668, People-Stokes/S.4111) Breslin, would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. The bill was revised from the version that passed both chambers two years ago, but was vetoed. To address concerns raised in your veto message in 2019, the legislation would prohibit the applicability of a mid-year formulary change for those patients who were on the medication at the beginning of the policy year, or suffer 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.
MSSNY & Patient Advocates Continue Discussions with Department of Financial Services (DFS) About Step Therapy Reforms
MSSNY joined patient advocates for a follow up call with staff at DFS this week to continue discussions about whether New York health plans are complying with the step therapy reform law that passed the legislature in 2016 and the possibility for further legislative reforms. Among the key items for discussion is ensuring greater transparency regarding the number of step therapy override determinations that have been made by various insurers, including having these figures be specifically enumerated within public documents from DFS that detail the numbers of internal and external appeals.
Step Therapy, also known as “fail first”, is a policy used by insurers to “control costs”, that requires patients to try and fail on one or more drugs prescribed by their physicians, before an insurer will provide coverage for the originally prescribed treatment. Step therapy protocols can also lead to serious health consequences and increased costs for patients. MSSNY was a key player in the coalition that worked to pass the law in 2016 that sets forth specific criteria that enable a physician to override a health plan step therapy protocol.
Department of Financial Services (DFS) Decision to Eliminate Cost-Sharing Waiver for Patients’ Telehealth Care Likely Permanent
With the announcement this week that the Governor was ending the declared state of emergency, it made it significantly more likely that the DFS’ recent decision to end an emergency regulation requiring insurers to waive out-of-pocket expenses for patients receiving care via Telehealth would not be reversed.
Early on in the pandemic, with the support of MSSNY and many other patient advocacy organizations, DFS and the state Department of Health (DOH), adopted critically important policies to better enable patients to obtain health care services via telemedicine, including waiving cost-sharing requirements for services delivered via telemedicine, expressly permitting coverage for health care services via audio-only, and allowing delivery of telemedicine services through basic smartphone video technologies. Medicare also followed this path, waiving the federal statute that limits Medicare coverage for Telehealth to rural areas and significantly increased the payments for video and audio-only Telehealth services. The current emergency regulation expressly stating that health insurers must cover “audio-only” telehealth services has been extended until July 6, and MSSNY will be urging that it be continued after that date.
Even as a significant portion of the population is immunized against COVID19, public health experts anticipate that Covid-19 will remain a public health threat for the foreseeable future, making continued expanded patient access to Telehealth services important. MSSNY will continue to advocate for measures that remove barriers to patients receiving Telehealth services from their physicians, including fair payments for these services. We will also continue to work with Assemblywoman Woerner (D- Saratoga, and Senator Rivera (D-Bronx), and a range of patient and provider organizations partners, in support of their bill (A.6256/S.5505) to require insurer payments for services provided using Telehealth are on par with in-office visits.
Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
Physicians are urged to contact Governor Cuomo to urge him to VETO Regressive Liability Bills. There are multiple problematic pro-trial lawyer bills passed at the end of the Legislative Session that if signed could have the effect of significantly disadvantaging defendants generally in litigation in New York State, including physicians and hospitals defending against malpractice claims.
While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts. These bills include:
- A2199/S473 – Expanding the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
- A8040/S7093 – Changing a long-standing rule that heretofore excluded a “hearsay”.
- A8041/S7052 – Imposing excessive insurance disclosure requirements on defendants during litigation.
Guidance for New York State COVID-19 Vaccination Program
All individuals 12 years of age and older that reside in the United States are eligible to be vaccinated. Performance, throughput, effort, and effective administration of vaccines by providers continue to be key factors in making future vaccine allocations, along with equity, access, and regional positivity rates.
All vaccine providers in New York State, including those located in the City of New York and those participating in federal programs, must follow New York State Department of Health (NYSDOH) guidance and directives, including the requirement to accurately and completely report doses administered to the appropriate immunization information system (NYSIIS or CIR) within 24 hours of vaccine administration per Executive Order 202.82 as extended by 202.89, and must maintain up-to-date inventory in such system.
Accurate and timely reporting to NYSIIS/CIR is critical, as this information can be used to allow individuals to display proof of vaccination, such as the Excelsior Pass.
NYSIIS/CIR Reporting Requirements for the COVID-19 Vaccination Program
NYSIIS or CIR access is required to submit requests for vaccine, manage COVID vaccine inventory, and report doses administered. As a condition of receiving federally funded vaccine, all providers must report:
Within 24 hours of administering a dose of COVID-19 Vaccine and adjuvant (if applicable), Organization must record in the vaccine recipient’s record and report required information to the relevant state, local, or territorial public health authority.
Organization must submit Vaccine-Administration Data through either (1) the immunization information system (IIS) of the state and local or territorial jurisdiction or (2) another system designated by CDC according to CDC documentation and data requirements.
For providers administering vaccine in New York State, submitting data to NYSIIS and CIR satisfies the federal reporting mandate. Providers should continue to submit this data to the NYSIIS and CIR within 24 hours of vaccination. Please continue to ensure you are entering all patient demographic and vaccine information completely and without errors.
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