Dense Breast Notification Signed by Governor
Despite District II’s strong opposition, Dense Breast Notification Legislation (S.6769B, Flanagan/A.9586D, Jaffee) passed the Legislature and was signed into law by Governor Cuomo on July 23rd. Click here for the governor’s press release.
Prior to the bill going to the governor, District II met with the sponsor in the Senate and the Assembly as well as the governor’s counsel and deputy secretary to express our concerns about the legislation. We explained how there is no clinical evidence that breast density alone is a cancer risk nor are there medical guidelines indicating what type of additional testing should be performed for women who’s mammograms detect dense breasts.
The law takes effect 180 days after it was signed by the governor.
Collective Negotiation Bills Fail to Pass
Despite strong support of organized medicine, including District II, neither the statewide collective negotiation bill (S.3186, Hannon/A. 2474A, Canestrari) nor the demonstration collective negotiation bill (S.7615, Hannon/A.2474B, Canestrari) passed either house of the Legislature. This is largely due to the very strong opposition from the health insurance industry, the business community and some major hospital associations.
Collective action is now prohibited under federal antitrust laws. As a result, with most regions of New York State being dominated by just one or two health plans, most physicians face one-sided contracts from health insurers with little if any opportunity to negotiate. It is the patient, however, who bears the brunt of this market dynamic because the physicians’ inability to negotiate results in the imposition of unnecessary barriers for patients as they seek to access necessary care. These health plan abuses include: cumbersome pre-authorization processes that delay patients from receiving needed care and testing; arbitrary limitations on necessary prescription medications; and overly aggressive barriers that limit patients’ ability to receive care from the specialist physician of their choice.
Out of Network Transparency Fails to Pass
The Senate passed comprehensive legislation (S.7745, Hannon) by a 55-5 vote that would enact a number of provisions to provide much needed transparency to patients and employers regarding the scope of their health insurance coverage when they pay for coverage that provides the right to see a physician outside of a plan’s network.
The Assembly did not advance the bill this session. However, passage by the Senate sets the stage for further discussions on this legislation with the Assembly and governor’s office, which are expected to continue over the summer and into fall.
Telemedicine Passes Both Houses
(S.6970, Young/A.9834, Gunther) would streamline the process to credential health care practitioners providing telemedicine services to patients in New York State. The bill, introduced by the Legislative Commission on Rural Resources, would allow a hospital that wishes to contract for practitioner services via telemedicine to arrange for the sharing of credentials verification paperwork used for granting hospital privileges. It also would allow the hospital receiving the telemedicine services to rely on the hospital providing the services for peer review and quality assurance activities.
Nurse Practitioner Independent Practice Fails to Pass
(A.5308A, Gottfried/S.3289A, Young) which District II opposed, would have permitted certain nurse practitioners to practice independently with a physician or directly with a hospital. The bill passed the Assembly, but did not pass the Senate. CLICK HERE for District II’s Opposition Memo.
OTHER LEGISLATION OF INTEREST
Pharmacists to Give Herpes Zoster Vaccine
District II has remained neutral on legislation that would allow pharmacists to provide the herpes zoster vaccine to adults. (A.6301B, Paulin/S.3808B, Fuschillo), which passed both houses of the Legislature, would authorize physicians to issue a patient specific script to pharmacists to allow them to provide the immunization. It would also let nurse practitioners prescribe and order a specific regimen to a licensed pharmacist, pursuant to regulations developed by the Commissioner of Health, for administering immunizations to prevent acute herpes zoster. The bill also would authorize pharmacists to administer medications required for emergency treatment of anaphylaxis for influenza, pneumococcal or herpes zoster vaccine. Currently, pharmacists have the ability to administer, through a non-patient specific script, the influenza and pneumococcal vaccine to adults.
Breast Reconstruction Insurance Coverage
(S.3801-A, LaValle/A.7193-A, Cook) would provide insurance coverage for breast reconstructive surgery after a patient has had a partial mastectomy. This legislation passed both houses.
(S.7355, Krueger) failed to move in the Legislature. This newly introduced bill would mandate all ob-gyns to successfully complete perinatal depression training to screen every mother. The legislation would also:
- Define perinatal depression.
- Require providers and carriers to report data on the perinatal depression screenings to the Bureau of Maternal and Child Health of New York State.
- Mandate maternal health professionals to screen every pregnant mother three times including: first trimester; third trimester; and during the six-week postpartum visit.
- Mandate maternal health professional to complete a training course developed by the New York State Department of Health and complete a questionnaire testing your ability to screen mothers and upon successful competition sign a screening authorization letter.
- Include fathers and other family members in the education and treatment process.
- Require insurers to add perinatal depression to maternity care coverage.
The Senate and Assembly Passed (S.6736/A.10623) to establish tighter online oversight of prescription drugs. The goal is to curb the black market fueled by painkiller addictions and doctor shopping. The measure would make New York the first state to establish mandating that physicians consult a database of a patient’s prescription history before prescribing most controlled substances. It would also require reporting by pharmacists when such prescriptions are filled.
Accountable Care Organization (ACO)
(A.8869B, Gottfried/S.6228B, Hannon), which would make the state Accountable Care Organization (ACO) demonstration program permanent passed both houses of the Legislature. This measure would enable Medicare Shared Savings ACOs special recognition under New York’s Public Health law and in so doing would afford, to the extent consistent with CMS regulations.
Expedited Partner Therapy
District II is concerned about a one-house bill (A.10277, Schimel) that would make permanent the provisions for Expedited Partner Therapy (EPT) and authorize its use for all sexually transmitted diseases (STDs). The bill did not move in the Assembly. District II supported the enactment of Chapter 577 of the Laws of 2008 to authorize expedited treatment for chlamydia trachomatis for the sexual partners of patients who have been diagnosed with the disease. According to the Center for Disease Control and Prevention, EPT is a “useful option to facilitate partner management, particularly for treatment of male partners of women with chlamydia infection or gonorrhea.” However, a review of the CDC EPT Report of 2006 indicates that extension to other treatment of other sexually transmitted diseases has limitations. District II is concerned about applying this treatment to the broad spectrum of STDs.
(S.5356-D,Young/A.8392-C, Paulin), a bill that is a title protection bill and does not expand the scope of practice of nurse anesthetists, passed both houses on the last day of session. The negotiated language ensures that there is no expansion of scope of practice.
Specific Risk Management Course in Obstetrics
(S. 5152B, Grisanti/A.344B, Paulin) passed the Assembly but failed to move in the Senate. The bill would allow for the development of a specific risk management course for ob-gyns rather than a general risk management course that is currently offered to all physician specialties.
Ban on Tanning Bed Use Under Age 17
(A.1074, Weisenberg/S. 2917, Fuschillo) passed both houses of the Legislature. The bill would build upon existing regulations in the use of tanning beds by prohibiting their use by children under the age of seventeen. Currently, indoor tanning is permitted for children 14 and older with parental consent.
Electronic Cigarette Ban
(A.9044-B, Rosenthal/ S.2926-B,Johnson), a bill that would ban the sale and distribution of electronic cigarettes to anyone under the age of 18 years, passed both houses of the Legislature.
Amended Palliative Care Information
An amendment to the Palliative Care Information Act (PCIA) has passed both houses. (S.7596, Hannon/A.10373, Goldfeder) would require that physicians and nurse practitioners provide patients with a terminal prognosis of six months or less with “information regarding other appropriate treatment options should the patient wish to initiate or continue treatment,” in addition to information and counseling regarding palliative care. The Palliative Care Information Act is designed to ensure that palliative care is included as an option. The language in the bill only reinforces an unfortunate bias that palliative care is the absence of treatment and is passive. Palliative care includes all sorts of treatment and is an additional layer of services that can be provided concurrently with curative treatment. The PCIA was originally approved by the Legislature in 2010 and required that physicians and other health care providers counsel patients who had six months to live about their palliative care options.
Medicaid Standard Prior Authorization Form
(A.10248-A, Gottfried/S.7384-A, Hannon) passed both houses. The bill would direct the Department of Health to develop a standard prior authorization form to be used by Medicaid managed care companies to determine coverage for prescription drug medications. This form would be available from managed care plans electronically as well as in paper format.
Legislation that would authorize the medicinal use of marijuana passed the Assembly. (A7347-B, Gottfried) would allow a licensed practitioner to certify that a patient has a serious condition and based on the practitioner's judgment can and should be treated with the medical use of marijuana. Under the bill’s provisions, a copy of the certification would be placed in the patient's medical records.
Ban on Smoking on Playgrounds
(A.6451-C, Galef/S.7627-A, Carlucci), a bill that would ban smoking on playgrounds, where children under the age of twelve years are present, passed the Assembly but was held in the Senate Rules Committee.
(S.1803-E, LaValle/A.3057-C, Perry), a bill that would license naturopathic practitioners and define their scope of practice, did not advance to the floor in either the Senate or Assembly.
ACOG DISTRICT II LEGISLATIVE ACTIVITIES IN 2012
Lobby Day 2012
ACOG District II’s Lobby Day was held on May 15. Compelling personal stories and professional knowledge played a major role in better informing and motivating legislators to take an important role in championing women’s health issues and the concerns of New York’s ob-gyns. According to one lawmaker, “ACOG holds a lot of weight in the legislature as an expert in women’s health.”
Members of the Assembly and Senate listened and responded to our members as they lobbied in support of:
- Allowing physicians to collectively negotiate contract provisions with managed care plans.
- Guaranteeing a woman can make her own personal and private reproductive health care decisions.
- Establishing the New York State Health Insurance Exchange for maternity care and direct access to primary ob-gyn care and services.
- Addressing homebirth patient safety standards.
- Comprehensive obstetric tort reform.
- Safeguarding the conversation between a physician and his/her patients regarding mammography (dense breast) test results.
Home Birth Proposal
Ob-gyns and Midwives are meeting on October 28 to discuss a wide range of collaborations – including the issue of homebirth standards.
Since the written collaborative agreements with midwives were eliminated, there is a great concern regarding homebirth midwives practicing not only without assistance from a physician but also with no patient safety standards in place. District II is committed to ensuring that every delivery in New York is held to the highest standards of care. Legislation is in the process of being drafted to require a homebirth registry, written plan for consultation, emergency transfer, and transport and informed consent.
- A homebirth registry would allow patients to look up midwives’ credentials and/or practice profile on a public website.
- A patient safety system is needed to handle situations in which an advanced level of maternity care is urgently needed. A protocol emergency for home-births would include transportation to the hospital, particular to each patient.
- Patients need to be informed about:
- Whether licensed midwives, but particularly home birth midwives have hospital privileges.
- Whether any licensed midwife has medical liability insurance coverage.
Taking on Med Mal Reform in NYC
Iffath Abbasi Hoskins, MD, FACOG, testified at the Committees on Health and Women’s Issues of the New York City Council on January 31. The committees are considering Proposed Res No. 84-A, calling upon the New York State Department of Financial Services and the New York State Department of Health to address the high cost of malpractice insurance for general practitioners, obstetricians, gynecologists and radiologists.
Dr. Hoskins spoke about the need for medical liability reform in New York. She stated in her testimony that the rising medical liability premiums are causing many of her colleagues to make drastic changes to their practices including decreasing the number of high-risk obstetrics patients they see, increasing the number of C-sections they perform, or giving up obstetrics all together.
Reproductive Health Act
(S.2844, Stewart-Cousins/A.6112, Glick) failed to move in the Legislature. The bill, supported by District II, would guarantee that every woman makes her own personal, private health care decisions with her physician. At the end of the Legislative session, District II participated in a Bi-Partisan Pro-Choice Women’s Caucus and a Senate Democratic Women’s Forum on health issues. District II addressed the important relationship between a woman and her ob-gyn and the need to discuss personal and private health care decisions. District II will continue fighting for passage of the Reproductive Health Act.
The Medicaid Redesign Team
The Medicaid Redesign Team (MRT) recommendations in Year II by the Basic Benefit Review Work Group including the elimination of Medicaid payments for non-medically induced cesarean sections prior to 39 weeks gestation, was approved by the Legislature and included in the final budget proposal. District II sent two letters to Department of Health Commissioner Nirav Shah on October 17, 2011 outlining ACOG’s concerns as well as a second letter on November 8, 2011 explaining medical indicators for inductions and C-sections prior to 39 weeks gestation. The details on how this new budget law will be implemented have yet to be determined. District II will continue to have dialogue with the Medicaid Redesign Team regarding this proposal as the Department of Health drafts guidelines.