A letter signed by 43 Assembly members urging a full restoration of last year’s crossover cut was sent to Assembly Speaker Silver this week. The letter was authored by Assembly Task Force on People with Disabilities Chair Kevin Cahill, Health Committee Chair Richard Gottfried, Mental Health Committee Chair Peter Rivera and Aging Committee Chair Steven Englebright.
Also signing unto the letter were Assembly members Aubry, Bradley, Brennan, Carrozza, Cook, A. Cohen, M. Cohen, Cymbrowitz, Destito, Delmonte, DiNapoli, Eddington, Espaillat, Galef, Gianaris, Glick, Gordon, Greene, Gromack, Gunther, Hooper, Hoyt, John, Kaufman, Koon, Lavelle, Lentol, Magnarelli, Markey, Norman, Ortiz, J. Rivera, Sanders, Schimminger, Seddio, Sweeney, Weinstein, Weisenberg and Wright.

Several other Assemblymembers have or will be sending individual letters urging the restoration of last year’s cut. MSSNY, in conjunction with several other health provider and consumer groups, is also asking individual Senators to urge Senate Majority Leader Bruno to include restoration of the crossover cut in this year’s State Budget.

Physicians are urged to continue their own advocacy efforts, as outlined in previous communications, by calling their respective state legislators to urge their support for full restoration of the cut. Senate: (518) 455-2800 Assembly: (518) 455-4100. 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.

The New York State Department of Health (DOH) this week sent letters to physicians stating that they have extended the February 18, 2004 deadline for submitting HIPAA compliant-only electronic claims to Medicaid. Instead, DOH will establish a set of staged implementation milestones for HIPAA compliance. According to the letter, as of March 24, 2004, all Point of Service (POS) devices must be HIPAA-compliant. TRANZ 330 devices will no longer be supported after March 24.

The only POS device that will be supported will be the VeriFone Omni 3750. The letter also provides that as of April 15, 2004, the old PACES software will no longer be supported, and that HIPAA compliant ePACES software must be used. The ePACES software is available free of charge. Information on PACES can be found at the website www.emedny.org, or by calling Provider Services at 1-800-343-9000.

The DOH letter also indicates that electronic claims will continue to be accepted in both HIPAA-compliant and non-HIPAA-compliant formats until such time that a substantial number of “trading partners” are able to submit HIPAA-compliant claims. DOH intends to re-examine its progress in June for the purposes of developing a new deadline for submitting HIPAA compliant-only electronic claims. Physicians can also obtain more information on Medicaid HIPAA compliance by calling the CSC HIPAA Support Helpline at 1-800-522-5518.

MSSNY’s Legislative Day has been scheduled for Tuesday, March 16th. Several Specialty Medical Societies will also be participating in concert with MSSNY.

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. Scheduled speakers include Senate Majority Leader Joseph Bruno, Superintendent Gregory Serio, Executive Deputy Commissioner of Health Dennis Whalen, Senate Health Committee Chair Kemp Hannon, Senate Insurance Committee Chair, James Seward, Assembly Health Committee Chair Richard Gottfried and Assembly Insurance Committee Chair Alexander “Pete” Grannis. In addition to listening to these important legislative and administrative leaders, 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. Your attendance at this meeting is important to our success.

Anyone interested in attending this event should call the Nassau County Medical Society at 516-832-2300 ext. 14. Plans are in place to use a charter flight from MacArthur to go to Albany and return on the same day. However, seating is limited and will be given on a first-come, first-served basis.

The 42nd Annual Medallion Ball honoring Burton Glass, MD will be held on May 1, 2004 at the Westbury Manor.

The deadline for ad placement in the Medallion Ball Journal is March 15. For more information call 832-2300 x14.

The Medical Society of The State of New York has sent a letter to Assembly Health Committee Chairman Richard Gottfried (D-NY) supporting his efforts to provide Medicaid reimbursement for interpretive services provided to non-English speaking patients in health care settings.

On Tuesday, February 24th the Assembly Health Committee is scheduled to consider a bill (A.8049-A) by Mr. Gottfried which would authorize Medicaid payments to hospitals, hospital-run outpatient treatment facilities and diagnostic and treatment centers. In its letter to Chairman Gottfried, the Medical Society points out those physicians and other health care practitioners in office settings are also required, by federal Executive Order, to provide interpretive services to patients with limited English proficiency, at the practitioners’ own expense.

These costs range between $30 and $400 and almost always exceed the payment received, under Medicaid, for the medical services provided. The Medical Society has requested Mr. Gottfried to amend his legislation to include physicians and other office-based practitioners within the scope of those receiving Medicaid reimbursement for interpretive services, in order to assure that Medicaid patients continue to have access to quality health care and preventative services in the office setting. The letter was also sent to all of the members of the Assembly Health Committee.

On February 10, Surgeon General Richard Carmona promoted a Bush administration plan to expand the 6,000-member US Public Health Service Commissioned Corps. Last July, HHS Secretary Tommy Thompson announced a plan to expand the corps - one of the seven Uniformed Services of the United States - through recruitment of more providers. The plan would establish scholarships to recruit 100 physicians each year to practice in medically underserved areas, improve and expand instruction for corps members, establish a reserve corps and make the corps 100% deployable by the end of 2005. Corps members would have to agree to be deployed immediately in an emergency. Only 30% of the corps currently is considered prepared for immediate deployment. Dr. Carmona, who supervises the corps, said, adding that the 2001 anthrax attacks and more recent natural outbreaks of diseases such as SARS highlight the need for the plan. HHS spokesperson Craig Stevens said that this is the largest expansion of the corps since it was established in 1889. 

Visit the corps’ website at http://www.usphs.gov/html/physician.html for more information.

Thanks to the advocacy efforts of MSSNY and the New Yorkers for Civil Justice Reform Coalition, as well as many individual physicians and businesses across the State, legislation (S.2994, DeFrancisco) was pulled from the Senate Judiciary Committee agenda. The bill would have radically increased amounts that can be awarded in wrongful death actions. If enacted, this legislation would require physician premiums to be increased by almost $400 million at a time when physicians already face enormous and rapidly rising liability insurance costs. This legislation will likely continue to be aggressively sought by the Trial Bar over the course of the Legislative Session. MSSNY and NYCJR will continue to be vigilant in monitoring this proposal.

MSSNY quickly responded to assertions made in a press conference this week that challenged MSSNY’s repeated statements regarding the threat to the health care system resulting from rapidly rising liability exposure and costs. The press conference was held by several consumer groups allied with New York’s trial bar. These groups alleged that an average across the Board increase of 8.5% in liability insurance was not significant, when one considers that medical inflation was 9.3% last year. In the first place, the 9.3% inflation factor is not physician specific but includes all health services. Physician fees increased at a rate much lower and in many cases went down.

MSSNY argued that physician liability insurance costs have actually gone up 27-43% (not just 8.57%) in the last two years, with these increases particularly acute for specialists who treat high-risk patients in the Metropolitan New York City area. Moreover, physician income has generally been stagnant or going down due to managed care cost containment and higher office overhead costs. MSSNY also challenged claims made by these groups that there were no service availability problems in New York State. In particular, MSSNY highlighted a recent ACOG study that showed that 40% of New York’s counties have less than 5 OB-GYNs and that 36% of the state’s OB-GYNs were over the age of 60. Also highlighted was a recent Excellus study showing that there are several regions of the State when at least 25% of the specialists in that State were over the age of 60. It was also noted that a recent New York City Council report showed a several month long wait time for women to receive mammograms in Queens County, one of the most expensive counties in the State for purchasing liability insurance. MSSNY also pointed out that several authoritative commentators have argued that the excesses of the civil justice system actually hinder, not enhance, systemic efforts to address medical errors.

Finally, MSSNY reiterated its call for meaningful civil justice reform as to preserve the health care system in the long term.

U.S. Senate Majority Leader Dr. Bill Frist (R-TN) has scheduled debate for February 23rd and a vote to suspend debate (invoke cloture) on February 24th on the "Healthy Mothers and Healthy Babies Access to Care Act of 2003" (S.2061).

The legislation was introduced on February 10th by Senator Judd Gregg (R-NH), Chairman of the Senate Health, Education, Labor and Pensions Committee, and Senator John Ensign (R-NV). If enacted, it would establish a $250,000 flexi-cap on non-economic damages, limit attorney contingency fees, provide for periodic payment of large awards and institute joint and several liability for medical malpractice judgments, settlements and arbitration awards against obstetrician-gynecologists.

On Friday, February 13th, the Board of Trustees of the American Medical Association voted to support the bill. This legislative maneuver is an attempt by Senator Frist to move forward toward a solution to the medical liability crisis that is causing serious patient access problems across the nation. Having failed to break a Democratic-led filibuster of a comprehensive professional liability reform bill (S.11) last year, Senator Frist and his colleagues have decided to approach the issue in a more focused fashion, by concentrating on one area of patient access problems at a time. Similar legislation relating to emergency care, rural health care and surgical care may be forthcoming in the near future.

The American Trial Lawyers Association is urging its members to lobby for a "no" vote, presumably on the cloture motion, to prevent any debate or vote on the actual merits of the legislation. The AMA is strongly urging a "yes" vote on both cloture and the bill. In the Senate, it takes 60 of 100 votes to invoke cloture. It is expected that the Democratic leadership will bend to the will of the trial lawyer lobby and oppose a final vote on S. 2061. If the bill were to be passed, it would go to a conference committee with the House of Representatives, which passed comprehensive liability reform last year (H.R. 5). Physicians wishing to find additional information on this topic can go to www.ama-assn.org/grassroots.

The Assembly Rules Report for consideration on Monday, February 23rd contains several bills which MSSNY supports which affect managed care practices and procedures in order to create more protections for consumers from HMO abuses and to help return clinical decision-making authority including:

• A.1162 (Kaufman): which allows a terminally ill patient to continue to see his/her health care provider after disenrollment from the plan;
• A.5013 (Gottfried): which requires the use of uniform credentialing and referral forms; and
• A.5733 (Gottfried): which allows patients to hold HMOs legally responsible for actions/decisions which cause harm.

MSSNY has issued memos in support of each of these measures and encourages its members to express their support for each bill to their Assembly representative.

The CDC has issued a recommendation that pediatricians delay the final dose of Prevnar, a popular meningitis vaccine, until a shortage of the vaccine eases.

Lance Rodewald, the director of CDC’s immunization services division, said that delaying the fourth shot would allow the conservation of over one million doses of the shot by July, leaving enough for children to get their first three doses. Officials also said the move would not pose a risk to children’s health. The agency said that children should be given the final dose of Prevnar, normally administered between 12 months and 15 months of age, when it becomes available. However, CDC added that "children with chronic diseases and other conditions that put them at high risk" should be given the fourth shot on schedule.

Invasive pneumococcal disease is the main cause of bacterial meningitis in the United States, affecting nearly 200 children younger than age five each year. According to the Wall Street Journal (2/13) Prevnar supplies, which have been short more than 50% of the time since it was introduced in February 2000, are affected by limited production abilities and a complex manufacturing process that involves combining seven vaccines into one.

Legislation (A.9736/S.6135) was introduced by Assembly Labor Committee Chair Susan John and Senate Labor Committee Chair Guy Velella to significantly revise the workers compensation process. Of interest to physicians are provisions that would increase from $500 to $2,000 the cost of care threshold triggering the obligation of the injured worker’s treating physician to seek authorization from the carrier before providing the care. This, of course, would significantly reduce the number of instances that physicians would need to seek pre-authorization. Also, the bill contains a provision that would require the injured worker’s health insurer to cover the costs of care if the workers compensation carrier contests the claim, if such health insurer would otherwise be responsible for paying for the costs of care. If the workers compensation carrier is subsequently adjudged to be liable, the carrier would be required to reimburse the health insurer. However, the legislation does not contain a provision that calls upon the carrier to reimburse the difference to the physician if the workers compensation fee is higher than the health insurer fee, which could result in some instances where carriers are "rewarded" for inappropriately contesting claims. Moreover, the legislation contains a provision to which MSSNY has raised serious objection that would impose on workers’ compensation-authorized physicians an annual fee of $100 for the purposes of funding of Workers Compensation Board training program for physicians regarding how to navigate the workers compensation claims process.

MSSNY has informed the Legislature that such provision is unnecessary and could cause some physicians to leave the Workers Compensation Program.

The New York State Insurance Department recently imposed over $400,000 worth of fines for violations by health insurers of New York’s Prompt Payment Law. The fines were imposed on 30 health plans. The highest fines included a $104,300 fine against Aetna, a $53,500 fine against Health Now, a $36,600 fine against United Healthcare, a $30,100 fine against Health Net and a $28,000 fine against Oxford. The fines were for violations by these health insurers in 2001 and 2002.

The Insurance Department noted that they received 13,577 Prompt Pay complaints in 2003, which is down 31% since 1998. However, it is still an extraordinarily high number of complaints. As a result, MSSNY continues to pursue legislative and regulatory remedies to address the problem of health insurers who continue to inappropriately delay or recoup funds from physicians. In particular, MSSNY continues to aggressively pursue legislation (A.6939, Sweeney/S.3015, Maziarz) that would limit to 90 days the time following payment that a health plan can recoup such payment from a physician or health care provider. MSSNY also continues to seek action by the Insurance Department to prohibit or substantially limit these inappropriate recoupments.

Legislation (A.8301, Tonko/S.5329, Libous) which would ensure that mental health and chemical dependency coverage is provided by insurers and HMOs on terms comparable to other health care and mental health services has been advanced to the floor of the Assembly. The bill has been named "Timothy’s Law" after Timothy O’Clair, a 12 year old boy from the Capital District who committed suicide three years ago. His parents, Tom and Donna O’Clair have stated that they had trouble getting him ongoing treatment because of the limit on the number of psychiatric visits allowed under their health plan. If enacted, Timothy’s Law would require insurance companies to provide the same level of coverage for mental illnesses as for physical illness thereby assuring that children like Timothy as well as adults living with mental illness or chemical dependency will have adequate access to the services they disparately need. The bill may be considered by the Assembly when legislators as early as February 23rd, when legislators are expected to return to Albany after a President’s Day recess.

Physicians interested in securing mental health parity legislation this year should send a letter to their legislators by accessing MSSNY’s grassroots action center requesting the enactment of Timothy’s Law.