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Archive for the ‘NEWS FROM THE NYS LEGISLATURE’ Category
|LEGISLATION WOULD REQUIRE GREATER EXPERTISE FOR HEALTH PLAN DENIALS
Tuesday, February 9th, 2010
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MANAGED CARE REFORM LEGISLATION ADVANCES IN ASSEMBLY
Wednesday, January 20th, 2010
The Assembly advanced a series of MSSNY-supported bills to provide comprehensive reform to the many hassles experienced by patients and physicians in their dealings with health insurance companies. Very significantly these bills included legislation (A.4301, Canestrari, Gottfried et al.) which was unanimously approved by the Assembly Health Committee and which fundamentally changes the nature of health plan-physician interactions by granting physicians and other health care providers the legal ability to collectively negotiate critically important patient care and reimbursement contract terms with health plans. The bill now advances to the Assembly Ways and Means Committee.
Additionally a number of bills that passed the Assembly last session, but not the Senate, have been advanced for consideration again by the full Assembly, including the following legislation:
- A.723 (Gottfried) – Would require a coverage denial decision made by a health plan to be made by a physician board-certified in the same or similar specialty as the physician who typically provides the recommended treatment.
- A.726 (Gottfried) – Would prohibit health plans from including certain offensive provisions in contracts with health care providers, such as limiting referrals to out of network providers, and “most favored nation” clauses
- A.729 (Gottfried) – Would better assure the ability of a patient to be successful in an external appeal of a health plan denial by facilitating evidence-based appeals founded on medical and scientific literature, the patient’s medical record, and other pertinent information.
- A.764 (Gottfried) – Would mandate the use by health plans of universal credentialing and re-credentialing forms
All physicians are asked to communicate their support for these bills to their elected member of the Assembly. All Assembly members can be reached by calling (518) 455-4100.
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NY MANAGED CARE REFORM LEGLISLATION TAKES EFFECT JANUARY 1, 2010
Tuesday, January 12th, 2010
As reported in Kern, Augustine, Conroy and Schoppmann “Statlaw”,
managed care reforms beneficial to physicians become effective January 1. Under the new law, providers who submit claims electronically must be paid in 30 days instead of 45 days and providers have at least 120 days to submit a claim, as opposed to the standard 60 or 90 days allotted by most contracts. Physicians are encouraged to take advantage of the new reforms.
For more information on any items mentioned in this Statlaw, visit www.drlaw.com.
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PHYSICIAN COLLECTIVE NEGOTIATION BILL
Tuesday, January 12th, 2010
Physicians are urged to call the members of the Assembly Health Committee to express your support for this bill. These Committee members are as follows:
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New 3-Year Physician Licensure Proposal from NYS Dept. of Ed.
Thursday, January 7th, 2010
The State Education Department (SED) Board of Medicine is seeking regulatory changes to physician licensure requirements for New York State and new requirements for maintenance of licensure.
Currently, a physician who has completed one year of post-graduate training and passed two of the three levels of the U.S. Medical Licensing Examination (USMLE) is eligible for a license in New York State. The proposed regulation would require that a physician complete three years of categorical residency training and pass the third level of the USMLE to be eligible for a license.
For maintenance of licensure:
- board-certified physicians would have to demonstrate continued competence by an authorizing entity approved by the Board of Medicine;
- non board-certified physicians would have to demonstrate continued competence by possessing credentialing verification and practice privileges at The Joint Commission-accredited hospitals;
- non-certified licensed physicians who do not have hospital privileges would have to demonstrate current competence by completing 50 annual hours of continuing medical education; and
- physicians licensed before these requirements would retain certification through a special “grandfather clause.”
Additionally, the Board is considering creating a “resident license,” to be renewed annually through SED at the resident’s expense. This license would enable a resident who meets all the specified criteria to write a prescription for medications or durable medical equipment without the explicit approval of a supervising physician. Currently, residents can write prescriptions that must be approved by their supervising physician.
The New York State Board of Medicine plans to develop language for these proposed regulations in January, for final passage in June.
MSSNY is planning to meet with Board of Medicine Executive Secretary Walter Ramos on January 11 to discuss these proposals.
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