Physicians are warned not to load the now obsolete 2004 Medicare rates into their billing systems and to throw away the CDs that were recently furnished by CMS. Also, do not use the obsolete hardcopy information and do not use information at the CMS website. The material had been furnished under a mandate that made distribution mandatory in early November despite the probability - now reality - that the Medicare billing rates would be changed under the new Medicare Drug Bill signed by President Bush.

MSSNY is in discussion with CMS as to when the new rates would be promulgated and what specific guidance is being issued in regard to January billing. MSSNY members will be kept abreast of developments.

William (Rick) Abrams, former COO of the American Health Care Association, has been appointed Executive Vice President of the Medical Society of the State of New York (MSSNY). Mr. Abrams succeeds Charles N. Aswad, MD, who has served as MSSNY’s Executive Vice President since 1993.

Before joining the American Health Care Association in 2000, Abrams spent 10 years as Vice President and then President and CEO of the New Jersey Association of Health Care Facilities. Prior, he had worked for New Jersey Governor Thomas Kean in a variety of assignments, including: Ombudsman for the Institutionalized Elderly, Director of Government Relations in the New Jersey Department of Health, Deputy Attorney General and Assistant Counsel to the Governor.

Mr. Abrams earned his BA from the University of Minnesota and his JD, cum laude, from Seton Hall University School of Law.

"Well, ladies and gentlemen, I’m completing my first week at MSSNY and I must say, it has been an exhilarating experience!  MSSNY is a leader in the State of New York and you (and I) are blessed with a competent staff that is passionate about what they do on your behalf. I am honored and thrilled to be here and committed to utilizing every ounce of my experience and energy to continue the many things that MSSNY does and, hopefully, to bring some new and successful ideas to the table to bolster our success as this great organization approaches its 200th anniversary.

In the ensuing weeks, you will be seeing and hearing a lot from me. I plan to spend much time in Lake Success and Albany getting acquainted with staff and the organization so that, together, we can make it the best it can be. I will also be getting out to learn about the great state of New York, my new home, and to talk to the policy makers whose decisions so impact what you do.

Once again, I am honored and humbled by the opportunity to be your new Executive Vice President. I am excited about working with you and the staff to build a prosperous future for us all!"

MSSNY’s Legislative Day has been scheduled for Tuesday, March 16th. Several Specialty Medical Societies will also be participating in concert with MSSNY. We ask all physicians to come to Albany where you will have the opportunity to listen to key legislators talk about what is happening in New York State. You will also have the chance to meet with your legislators to talk about the issues that are most important to you and your fellow physicians,  to their practice, as well as public health. The day consists of a briefing on legislative issues, lunch with legislators and personal legislative visits

MSSNY has a comprehensive legislative agenda to address issues of concern in the area of tort reform, managed care, Medicaid reform, including repeal of the ‘crossover cut’, public health, quality of care improvement, non-physician scope of practice, and coverage for the uninsured. Your attendance at this meeting is important to our success.

Please contact Nassau County Medical Society to obtain more information concerning this important event and to arrange transportation.

Due to changes that occurred so late in the year, the Centers for Medicare & Medicaid Services (CMS) is extending the Medicare participation enrollment period for 2004. The Medicare participation enrollment period is continuing beyond December 31, 2003, because the Medicare carriers will accept enrollment forms that are postmarked as late as February 17, 2004. Thus, the complete enrollment period runs from November 14, 2003, through February 17, 2004. Although the enrollment period runs until February 17, 2004, the effective date of the agreement will be January 1, 2004, and Medicare will be ready to process your claims in a timely and accurate manner. If a physician changes his/her participation status by submitting a form after December 31, 2003, the physician should begin submitting claims in accordance with the participation decision conveyed as soon as the form is submitted.

Enrollments and withdrawals for 2004 that are received after December 31, 2003, will be recorded in the carrier’s system as soon as possible after receipt. Until the agreement form is received and recorded in the carrier’s system, the 2004 claims filed will be processed using the physician’s 2003 participation status. Such claims will not be reopened or reprocessed once the form and participation status are recorded unless the physician specifically notifies the carrier to do so.

On Wednesday, January 7th, Governor George E. Pataki issued his 10th State of the State address to the Legislature. The Governor’s address was built around the theme of protecting citizens and enhancing freedom. In his speech, he set out an ambitious, detailed agenda which included making New York the safest state in America within five years, creating one million new private sector jobs by the end of the decade, making New York the national leader in renewable energy and open space preservation, reforming New York’s education system to ensure that it is the best in the nation and continuing the aggressive timeline for revitalizing lower Manhattan.

In the health care arena, Governor Pataki announced a new cancer prevention and screening initiative aimed at Hispanic New Yorkers, proposed comprehensive reforms to the long-term care system, called for improving and stabilizing the financing of the Medicaid system and for action to remove the Medicaid cost burden from local governments.

The Governor also called upon the Legislature to enact tort reform for local governments.

Responding to the address, MSSNY President Dr. Jeffrey Ribner said, “We applaud the Governor for his strong commitment to improving New York’s health care system and we offer our continued assistance in attaining the brighter and healthier future envisioned by Governor Pataki for all New Yorkers .” He also said that, “We are also pleased to note that the Governor called upon the Legislature to enact municipal tort reform, which we strongly support and which must proceed in tandem with general liability reform.” Senate Majority Leader Bruno responded to the speech by saying, “I applaud Governor Pataki for outlining a vision for New York State that will improve the quality of life for all New Yorkers.” and “Health care, especially Medicaid reform, will be a Senate priority.” Assembly Speaker Sheldon Silver said, “Let me assure you that the Assembly is not only prepared, but would prefer to work with the Governor and with our colleagues in the Senate in addressing the challenges facing our State.” Speaker Silver stated unequivocally, “Health care is a necessity. We will not let the Governor treat it as anything less.”
The Governor’s Budget Proposal will be presented to the Legislature in about two weeks. Obviously, the fate of many of the proposals contained in the State of the State is externally tied to fiscal budget reductions.

Assemblyman Kevin Cahill (D-Ulster County) introduced legislation (A.9345) this week that would restore the full coinsurance payment for physicians and other providers who treat patients dually eligible for Medicare and Medicaid. This 80% cut in the coinsurance payment that Medicaid pays for dual eligible patients, enacted in last year’s State Budget, has recently begun to be implemented by the State Department of Health.
The new legislation has 18 majority co-sponsors from various regions across the State, including the following counties: Albany (Canestrari); Bronx (Greene, P. Rivera, J. Rivera); Erie (Peoples); Kings (Boyland, Cymbrowitz, Seddio); Monroe (John); Nassau (Weisenberg); Oneida (Destito); Queens (Markey); Rockland (Gromack); Richmond (Lavelle); Suffolk (Eddington, Sweeney) and Westchester (Bradley). If your Assemblymember is listed above, we urge you to call them to thank them for co-sponsoring this measure. If your Assemblymember is not on this list, we urge you to call them to request that they ask to co-sponsor this measure.
In addition to this step, we also urge physicians to call the “Restore Crossover” hotline, 1-866-867-8829, which generates a letter to Governor Pataki, Speaker Silver and Senate Majority Leader Bruno in support of a repeal of the cut. Physicians can also send a letter to their legislator from the MSSNY Grassroots Action Center at www.mssny.org.

Pursuant to legislation enacted in January of 2002, eligibility for the Excess Medical Liability Program is contingent upon completion of an excess risk management course. Regulations implementing the risk management course requirement have been promulgated and courses offered by several medical malpractice carriers, including MLMIC, HIC, PRI and Academic Health have been approved by the State Insurance Department.

Because of the delay in regulation implementation and course development, physicians who participated in the Excess program during policy year July 1, 2002-June 30, 2003 have been permitted additional time - until March 1, 2004 - to complete a risk management course. Physicians who fail to complete the program, which includes five hour basic course taken either in a classroom setting or through the internet and the completion of a project (such as a critical review of case studies) would be deemed ineligible for the excess program for such policy year and any subsequent policy years for which no such course is taken.

Physicians who have not yet completed an excess risk management program are urged to immediately contact your medical liability carrier to determine the time and location of the next available excess risk management program.

The New York State Assembly Republicans unveil a “Road map to Renewal” this week at a press conference.

The Republican agenda includes proposals for new tax incentives to promote jobs and an expansion of the state’s Empire Zone.

The agenda also called upon the Legislature to assure, in the next five years, all local costs of Medicaid and for counties $200 million to help pay for medical costs.

A proposal to convert the Health Insurance Plan of Greater New York (HIP) to a for-profit health plan is currently being discussed in Albany. First founded in 1947 as a pre-paid group practice health plan conducting business in New York City, Long Island and Westchester.

For most of its history, HIP has arranged for medical care through contracted medical groups at medical centers which HIP owned or leased. Beginning in 1997, HIP began to expand its provider network and now offers a variety of HMO products for its approximate 849,000 members. As it advanced arguments on behalf of physicians who discounted fees to serve the Empire Blue Cross Blue Shield enrollees.

MSSNY will argue that that a portion of any public monies which accrue as a result of the HIP conversion should be directed to serve public health priorities identified by MSSNY and its physician members.

Finally, the 2004 revised Medicare fee schedules are available at Medicare Carrier websites.

• Empire Medicare Services ( serving Manhattan, Brooklyn, Bronx, Westchester, Richmond, Rockland, Nassau, Suffolk, Putnam, Sullivan, Orange, Dutchess, Ulster, Columbia, Delaware and Greene counties). Please review at their website at
  http:/www.empiremedicare.com/fees/feesindex.htm
  
• Group Health Incorporated (GHI)- Medicare (serving Queens County) Please review at their website at · http://www.ghimedicare.com/provider/2004physicianfee.html.  Any physician using the GHI website is cautioned if they choose to use the html format listed. The above site currently shows facility and non-facility revised fees in html format. If you are a non-participating Medicare doctor in Queens, NY you will have to calculate the non-participating fee by subtracting 5% based on where the service is rendered (i.e. facility or non-facility). After this calculation is made, the non-Medicare participating physician will then have to calculate the applicable NYS limiting charges, as described below, before billing patients on non-assigned Medicare claims. Please note, the PDF and CSK (excel) formats appear to show the routine Medicare Physician Fee Schedule listings of Par, Non-Par, and [federal] limiting charge columns.
  
• Upstate Medicare Division (UMD) (serving the 45 counties of upstate NY) Please review at their website at · http://www.umd.nycpic.com/fees.html#04FeeSchedule

If a physician is a non-participating Medicare doctor and chooses not to accept assignment for a specific claim (meaning he/she will be billing the patient directly), the physician will then need to calculate the NYS Limiting Charge of 105% for all Medicare covered services billed to patients. The only exceptions to the 105% NYS charge limit are the home (99341 - 99350) and office medical care visit (99201 - 99215) codes, which can be billed at the listed federal limiting charge of 115% of the non-par fee schedule.

Governor Pataki’s Health Care Reform Working Group issued it’s Interim Report this week which called for implementing several structural reforms in the Medicaid system focused primarily on long term care (LTC), certificate of need, local share of Medicaid costs and prescription drug costs. If the recommendations are implemented, the Working Group contended that the Medicaid program would save more than $4.2 B over the next five years. Additionally, local governments would save more than $2B. Among the major recommendations contained in the report are:

• Re-structuring the Medicaid funded long term care program by implementing a single point of entry (NY ANSWERS) which will encourage the use of most integrated care settings, recognizing and using informal supports in the home, better coordinating care and finding alternative non-medical services too lessen the need for medical services.
• Modifying Medicaid eligibility for LTC by imposing an asset transfer penalty on home and community-based care, eliminating “spousal refusal” and further limiting the ability of individuals to transfer assets to qualify for Medicaid in nursing homes.
• Expanding and improving LTC insurance options by: modifying the partnership plan (which combines private LTC insurance with Medicaid coverage) to enhance participation by referencing only one year of nursing home coverage and three years of home care instead of three years of nursing home care; creating a government funded reinsurance mechanism for long term care insurance; introducing LTC savings accounts; encouraging employer and union participation in LTC insurance plan; and allowing children and families tax incentives when paying for long term care premium for another family member.
• Enrolling dual eligibles in a new program which is a hybrid product of Medicare +Choice and Medicaid managed care that would include long term care services in the benefits package.
• Rightsizing nursing homes and encouraging innovative approaches to state-of-the-art nursing home construction and renovation.
• A state-takeover of the local share of LTC Medicaid costs contingent upon the adoption of other cost savings measures contained in the report.
• Implementing preferred and prior authorization drug programs that encourage the use of drugs that are therapeutically appropriate and cost effective.
• Enrolling SSI recipients in Medicaid managed care.

The report notes that other issues such as fraud and abuse, technology advancement, right-sizing of the hospital industry, regulating the pharmaceutical benefit managers, and encouraging greater utilization of primary care in community based settings will continue to be reviewed by the Work Group which will issue additional recommendations in the near future.