Neurology Signs On: Advocacy Report 2022

The New York State Neurological Society signed on to advocacy letters:

• joining the American Neurological Association in asking Congress to authorize the continuation of all current telehealth waivers through December 31, 2024; require HHS complete all feasible evaluations related to telehealth by fall 2023 and combine findings into a single overarching dashboard with recommendations to inform permanent telehealth legislation by Congress; and take up permanent, evidence–based telehealth legislation for implementation in 2024;

• rejecting the recommendation in the New York State proposed budget to repeal the authority of physicians and other qualified prescribers to make the final determination regarding the medication prescribed to individuals covered under Medicaid Fee–for–Service and Medicaid Managed Care, commonly referred to as “prescriber prevails;”

• rejecting the move to restructure New York State’s Excess Medical Malpractice Insurance Program by requiring the nearly 17,000 physicians currently enrolled in the program to pay upfront to be enrolled in the coverage, and then hope to be reimbursed by the State in two yearly installments; and

• protecting the requirement in the New York State Education law for a nurse practitioner to engage in a collaborative practice agreement with a physician for the delivery of primary care services, rather than practice with no such collaboration or supervision.

As the legislative season continues, NYSNS will continue to support our specialty, our profession, and most important, our patients.

New Legislation Session in 2021

What Is NYSNS Fighting and Supporting?

The New York State Neurological Society has joined with specialty societies around the State and the Medical Society of the State of New York in taking a stand against a multitude of adverse legislative action aimed at physicians during this legislative session. Here are sign–on letters the Society have been a part of today. (Remember, although not every issue is specific to neurologists, all deserve attention if they are hostile to our profession.)

The Patient Medical Debt Reduction Act
(A.3470–A/S.2521–A). This proposal, designed to make it easier for patients receive clear, concise, and timely bills, is well intentioned, but it poses a serious problem: It would require that the patient receive just one single bill for all of the hospital and physician services the patient had received. A physician or other provider with any financial or contractual relationship with a hospital would not be allowed to bill the patient separately. This prohibition will fall most adversely on physicians who are on the front lines of the pandemic, many of whom have seen an enormous drop in patient volume due to a significant amount of delayed care.
Let your legislators know that you appreciate the intent to minimize the financial burden on our patients, but that this “single bill” component will hit community physicians hard.

The Excess Layer Medical Liability Program
Governor Andrew Cuomo’s Budget proposes that the excess layer medical liability program be cut by 50%. The proposal would require the nearly 17,000 physicians currently enrolled in the Excess Medical Malpractice Insurance program to bear 50% of the cost of these policies, thrusting over $50 million of new costs on the backs of community–based physicians, including thousands of physicians who have been on the “front lines” of responding to the coronavirus percent” In the absence of comprehensive liability reform to bring down the exorbitant costs of medical liability insurance premiums in certain medical specialties and locales, this coverage is crucial.

Telehealth
The Governor’s budget has proposed new Telehealth legislation, but physicians have serious concerns. Telehealth has expanded during the pandemic, and the Governor is proposing some new, positive steps, including requirements for insurers to offer telehealth programs; elimination of outdated “location” rules; and interoperability requirements for telehealth platforms. However the proposal leaves out payment parity for telehealth visits. Insurers’ payments for audio and video telehealth has not kept pace with payment for in–office visits. Fewer than a quarter of health plans set their telehealth reimbursement levels for equal to what they paid for in–office visits; least compensated were audio–only visits.

A second concern is unintended consequences, as the insurance industry finds ways to use the Governor’s budget proposal to actually reverse the telehealth gains we have made over the past year — an effort completely at odds with the expansive approach to telehealth coverage taken by New York’s Department of Financial Services and Department of Health. Insurers can assert that they have an adequate network through a national telehealth service provider, and then exclude coverage of telehealth service by some or all of its in–network community–based physicians, wrecking havoc with doctor/patient relationships.

Due Process in OPMC Proceedings
Last year’s troubling proposal that would strip due process from physicians with complaints lodged with the Office of Professional Medical Conduct is back again.

Interest Rate on Court Judgements in Medical Liability Cases
New York’s 9% interest rate on court judgments is higher than market rates and is one reason why New York State’s medical liability costs are more than any other state. The Governor’s budget would tie the judgment interest rate to market rate (right now that would reflect a 6% savings).

Prescriber Prevails
Right now, New York State’s Medicaid program (both managed care and fee for service) has “prescriber prevails” protection. There is a proposal to repeal the provision “Prescriber Prevails” which means patients may have difficulty getting medications they need – particularly after the upcoming “transitioning” of the two Medicaid formularies into just one formulary.

Scope of Practice Encroachments
The Society continues to support the concept that training dictates what a health care professional does, and no ancillary profession should work beyond its training. We stand with our fellow specialists when it comes to optometrists prescribing and pharmacists prescribing and ordering labs without coordinating with patients’ physicians, among many other attempted inroads.

Thanks to Society president Mill Etienne, MD and Advocacy Chair and VP/President–Elect for guiding the Society on advocacy issues.

Legislation Session Ends With These Results

Legislature passes bill to reduce certain prior authorization requirements, preventing interruption of care.  A.2880-B/S.5328-B is designed to reduce insurer prior authorization (PA) requirements when a PA for a related procedure has already been received.  If a physician providing a treatment for which a PA has been received determines that providing an additional or related service or procedure is “immediately necessary as part of such treatment,” and that it would not be “medically advisable to interrupt…care” in order to obtain a PA, then the insurer is not permitted to deny the claim, except under limited circumstances.

Legislature rejects Liability Expansion bills that could have greatly increased premiums.  Though the trial lawyers aggressively pushed the State Legislature on several adverse bills in the Session’s final days, the Legislature left Albany without taking action on many of the trial lawyers’ high-priority bills, which would have driven up liability costs and made it harder for physicians to defend themselves in medical liability actions. These bills would have: Exponentially expanded awardable damages in wrongful-death lawsuits (S.4006/A.5612); prohibited a defendant physician from interviewing a plaintiff’s treating physician (S.6194/A.2370); and permitted the admissibility of certain “hearsay” statements by employees (A.7599/S.6335).

Legislature passes bill  assuring that the only permitted exception to New York’s vaccination requirements will be when there are medical contraindications. Governor Andrew Cuomo has already signed this bill into law.  The bill allows a school-age child who has begun the immunization process to attend school in Fall 2019. The law becomes fully effective in June, 2020. NYSNS was part of a coalition of specialty societies and public health and education entities, led by the Medical Society of the State of New York, to fight for this measure.

Legislation Update  June 19, 2019

The State Legislature is currently considering multiple bills that would drastically increase medical liability insurance premiums and decrease patients’ access to essential health care services.  Malpractice payouts in New York State continue to be far out of proportion to the rest of country, and WalletHub has again listed New York as the worst state in the country in which to be a doctor.  Send emails right now!  Go to  Write an Email NOW

 

Wrongful Death (S4006 Hoylman/A5612 Dinowitz) – passage could increase premiums by 47 percent!  This bill would expand wrongful death awards by adding compensation for grief or anguish, and for the loss of love, companionship, nurture, guidance, services and support.

“Patient Privacy Act” (S6194 Parker/A2370 Dinowitz):  The defendant physician’s attorney would not be permitted to interview the plaintiff’s treating physician – and so, would be less able to evaluate the claim.

Liability Exposure (S6081 Hoylman/A2372 Dinowitz):  This bill would “jump over” current law, whereby the plaintiff can only receive what the jury has awarded.  Under certain circumstances the plaintiff could be unjustly enriched.

 

Recovery Against Third-Party Defendant (S6552 Skoufis/ A2372 Dinowitz):  The plaintiff – bypassing the defendant he or she had actually sued – could go after a third party the defendant had sued (for contribution or indemnification).

Admissibility of Opposing Party’s Statement (S6335 Hoylman/ A7599 Dinowitz):  Despite years of legal precedent, if this bill passed, “hearsay” could actually be admitted (given an employment or agency relationship)!  The result could be unfair and inaccurate claims.

Legislature passes bill to reduce certain prior authorization requirements, preventing interruption of care.  A.2880-B/S.5328-B is designed to reduce insurer prior authorization (PA) requirements when a PA for a related procedure has already been received.  If a physician providing a treatment for which a PA has been received determines that providing an additional or related service or procedure is “immediately necessary as part of such treatment,” and that it would not be “medically advisable to interrupt…care” in order to obtain a PA, then the insurer is not permitted to deny the claim, except under limited circumstances.

Legislature rejects Liability Expansion bills that could have greatly increased premiums.  Though the trial lawyers aggressively pushed the State Legislature on several adverse bills in the Session’s final days, the Legislature left Albany without taking action on many of the trial lawyers’ high-priority bills, which would have driven up liability costs and made it harder for physicians to defend themselves in medical liability actions. These bills would have: Exponentially expanded awardable damages in wrongful-death lawsuits (S.4006/A.5612); prohibited a defendant physician from interviewing a plaintiff’s treating physician (S.6194/A.2370); and permitted the admissibility of certain “hearsay” statements by employees (A.7599/S.6335).

Legislature passes bill  assuring that the only permitted exception to New York’s vaccination requirements will be when there are medical contraindications. Governor Andrew Cuomo has already signed this bill into law.  The bill allows a school-age child who has begun the immunization process to attend school in Fall 2019. The law becomes fully effective in June, 2020. NYSNS was part of a coalition of specialty societies and public health and education entities, led by the Medical Society of the State of New York, to fight for this measure.

Legislation Update    June 14, 2019

The New York State Neurological Society is proud to have been part of the coalition that fought for immunizations and a stop to the measles epidemic in New York.   If you have a moment, thank Assemblymember Jeffrey Dinowitz (office number  (518) 455-5965) from the Bronx  and Senator Brad Hoylman (office number  (518)455-2451) from  Manhattan.  They continued a fight in the face of vocal and intimidating opposition.

Cuomo signs ban on nonmedical vaccine exemptions https://www.crainsnewyork.com/health-care/cuomo-signs-ban-nonmedical-vaccine-exemptions … via @CrainsNewYork

Legislation Update   May 4, 2019

The Board of Directors of NYSNS has signed on with a number of other medical societies around the State of New York supporting  1) Assembly Bill 2371/Senate Bill 2994 which would clarify that the only permissible exception from New York’s vaccination requirements is for patient medical conditions that would place patients who are immunized at risk for adverse outcome; and 2)  Assembly Bill 3038/Senate Bill 2847 which would significantly reduce the exorbitant pre-authorization barriers experienced by patients and their physicians that get in the way of timely treatment and medication and would help to protect consumers’ access to their prescription drugs.