The case stayed at the Tarrytown Marriott in Tarrytown, NY from approximately 5:30 PM on 7/23/2010 to shortly before noon on 7/24/2010. He developed prodromal symptoms on the evening of 7/23/2010 and rash 7/24/2010. The case was seen at a local emergency department on 7/24/2010 and was promptly admitted to the hospital in airborne isolation.  Measles was confirmed by IgM by the NYSDOH Wadsworth Laboratory on 7/27/2010. The case had minimal contact with the public outside of the Tarrytown Marriott between his arrival in Tarrytown on 7/23/2010 and his hospital admission on 7/24/2010.

Providers should increase their index of suspicion for measles in clinically compatible cases.  Any suspected case of measles should be reported immediately to the local health department (LHD) where the patient resides. LHDs should notify the NYSDOH Bureau of Immunization to arrange for appropriate testing for confirmation.
All contacts of cases should be immune or fully vaccinated according to age as recommended by the Advisory Committee on Immunization Practices (ACIP).

Measles continues to be endemic throughout the world. Recent outbreaks have been reported in France, Spain, Russia, the Philippines and several countries in Africa. Because of the risk of measles in both developed and developing countries, providers should ensure measles immunity in their patients who travel abroad or who will be in contact with international travelers, regardless of the travel destination.

Although not a step-by-step guide, it does provide information on the following:

§  Helpful tips to avoid the most common application errors

§  Separate sections for both PECOS and paper submission of applications

§  Valuable contact information

§  Information regarding timeliness / turnaround time for processing applications

§  Information on where to mail the application

§  A reminder of what documents may need to be included

§  Answers to the most frequent asked questions

This CBT takes approximately 15 minutes to complete and while not answering every question, it covers a large percentage of the most common errors we see with submitted applications.

Thank you!

The bill was delivered to the Governor for his consideration this past Monday, so by law he must take action by the end of next week. Physicians can send a letter to Governor Paterson by clicking here.

Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective July 28, 2010.

Please visit: https://newyork.fhsc.com/

The preferred drug list can be found at:

https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf

A ‘quicklist’ of preferred drugs only can be found at:

https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDLquicklist.pdf

All changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications.  Notifications will no longer be mailed to providers.

We appreciate your support of the New York State Medicaid Program.

Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

Summary: Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF). The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas–both domestic and abroad–who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.

Background

Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean. This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific. With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.

Symptoms

Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence. A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count ≤100,000/mm³), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock. Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

Recommendations

· Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing. DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.

· Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.

· Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing.  State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.

· If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form (http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.

Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.

Type of specimen        Interval since onset of symptoms          Type of Analysis

Acute                                         until day 5                                                RT-PCR for dengue virus

Convalescent        6 to 30 days        ELISA for dengue IgM

Centers for Disease Control & Prevention

Dengue Branch

1324 Cañada Street

San Juan, Puerto Rico 00920

Tel: (787) 706-2399; Fax (787) 706-2496

For More Information

· Instructions for the preparing and delivering specimens for dengue testing to the CDC Dengue Branch is available at: www.cdc.gov/Dengue/resources/TestpolEng_2.pdf.

· Additional information about dengue is available at: www.cdc.gov/dengue

· Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636 ) TTY: (888) 232-6348, which is available 24 hours a day, every day.

CMS denied NACDS’ request to reinstate the Jan. 3 deadline. However, the agency said that it will “for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers” whose application have not been approved by July 6.

About 800,000 providers successfully have enrolled through PECOS, but “some providers have encountered problems,” CMS said, adding that it will continue to remind providers to enroll and help them with the procedure, as well as “process all applications expeditiously.”

The law requiring this went into effect January 1, 2008.  Now that the two-year phase-in implementation period has expired, physicians who are not yet using the NYSIIS could be subject to monetary penalties.  So far, however, the NYSDOH prefers to focus its efforts on training physicians and their staffs on how to use online NYSIIS. The NYSDOH letter explains how to set up a Health Commerce System (HCS) account, describes the two NYSIIS user roles and outlines the various training options for physicians and staff. For more information, please click here.

Access to a computer and the Internet is the basic requirement for using the web-based NYSIIS. Every physician and staff person who might enter data must then set up a Health Commerce System (HCS) account. The practice should also determine who will be a NYSIIS Administrative User and who will be a NYSIIS Standard User. Once roles and HCS accounts have been established, physicians and staff can then select amongst numerous training opportunities that are appropriate for their NYSIIS role and fit their learning style/schedule.

4 Free Training Options – The NYSDOH offers four free NYSIIS training options:

• Classroom Training – Standard User Only

• Webinar Training – Both User Roles (Live and Recorded Sessions)

• User Manual – Available in Hardcopy and Online

• Self-guided Online Tutorials – Available through the NYSDOH Health Commerce System (HCS) portal.

Classroom Training Schedule (July-December) – Classroom training is being offered in the following cities across the state on the following dates.  Complete location and time details are in the NYSIIS Statewide Training Schedule (July – December 2010)

FULL SCHEDULE

Commack – July 27-28, December 8-9

Westbury – August 11-12

White Plains – August 24-25

Amherst – September 15

Rochester – September 16

Plainview – November 9-10

The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need.  PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.

As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010.   While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems.  CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.

CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order  home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B.  The new law applies to orders, referrals and certifications made on or after July 1.  The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.

The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation.  These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.

While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS.  However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.

Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.

CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.