January 20, 2015

NY AG Schneiderman Looks to Bolster State Privacy and Security Laws

New York Attorney General Eric Schneiderman has called for an upgrade to the state's information security and privacy laws, according to a press release issued by the AG's office January 15th.

Given the prevalence and increase of data breaches over the past several years, it is clear that New York - and the United States as a whole - is in need of progressive legislation to protect consumers and businesses.

The AG intends to make New York's data protection laws the strongest in the nation.

January 14, 2015

Medicare Begins Paying Primary Care Docs for Care Coordination

An AP wire covers this development in Medicare reimbursement.

Starting this month, Medicare will pay primary care doctors a monthly fee to better coordinate care for the most vulnerable seniors -- those with multiple chronic illnesses -- even if they don't have a face-to-face exam.

The change was part of the final rule for the 2014 Medicare physician fee schedule issued in December 2013. Although supported in the physician community when first announced, the general reaction seemed to be that the amount offered - - about $40 per month - - was only halfway reasonable, as an article at MedPage suggested.

Here's a snippet from the Final Rule for the 2014 fee schedule, discussing the proposal:

[W]e believe that the resources required to furnish chronic care management services to beneficiaries with multiple (that is, two or more) chronic conditions are not adequately reflected in the existing E/M codes. Therefore, for CY 2015, we proposed to establish a separate payment under the PFS for chronic care management services furnished to patients with multiple chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

We also stated our intent to develop standards for furnishing
chronic care management services to ensure that the physicians and practitioners who bill for these services have the capability to provide them.

See 78 Fed. Reg. 74415 (Dec. 10, 2013). See also 79 Fed. Reg. 40364 (July 11, 2014).

January 7, 2015

New York Enacts Telehealth/Telemedicine Mandate

Governor Cuomo has signed into law the telehealth/telemedicine mandate passed by the legislature at the end of its June 2014 session.

Chapter 550 of the Laws of 2014, signed December 29, requires health insurers and Medicaid to cover health care services provided via electronic means by providers located at a "distant site" if the health care services would otherwise be covered services.

Read the full text of the law here.

For a good overview of the legal issues in telemedicine, see Frank Serbaroli's May 27, 2014 New York Law Journal Article, "Telemedicine: Legal and Practical Considerations."

January 5, 2015

NY Missing From Leapfrog's 2014 'Top Hospitals' List

The Leapfrog Group has released its 'Top Hospitals' of 2014 and not one New York hospital made the list.

The Leapfrog Group is an employer-based coalition advocating for improved quality, transparency and safety in hospitals.

See the list an a brief accompanying article at Healthcare IT News.

December 23, 2014

Obama Administration Investigating Discriminatory Benefit Designs

Yesterday's New York Times reports that the Obama administration intends to investigate companies in the federal insurance marketplace it suspects of engaging in unlawful discrimination against people with AIDS, mental illness, diabetes and other costly chronic conditions.

The administration intends to focus benefit design aspects such as formulary structure, member cost-sharing, and prospective utilization review.

Read the full NY Times article here.

December 22, 2014

Governor Releases Medical Marijuana Regulations

On Thursday, December 18 Governor Cuomo released draft regulations for the State's medical marijuana program.

The regulations will be published in the December 31, 2014 State Register. The regulations will be open to a 45-day public comment period after that.

See the Governor's press release here or link straight to the draft regulations.

Forty-one New York Hospitals Face Medicare Cuts for Poor HAC Scores

Kaiser Health News is reporting that 721 hospitals will receive a 1% reduction in their Medicare reimbursement for FY2015 due to poor hospital-acquired condition (HAC) scores.

In New York, 41 of the state's 157 hospitals will experience the reduction. The penalties for all 721 hospitals will amount to $373 million.

HAC scores across all 3284 hospitals in the nation ranged from 10 to 1, with 10 being the worst. Only one New York hospital -- Massena Memorial Hospital in St. Lawrence County -- fell into the "10" category. Three New York hospitals tied with the lowest score of 1, including Bon Secours Community Hospital in Orange County, the Hospital for Special Surgery in New York City, and St. Mary's Healthcare in Montgomery County.

The complete data download is available at the Kaiser Healthnews website.

December 17, 2014

New York Gets an "F" For Physician Quality Transparency

Becker's Hospital Review notes a recent study that gives New York an F for physician quality transparency.

The Health Care Incentives Improvement Institute flunked 40 states and Washington, D.C., and gave four states a "D" in providing objective, publically accessible information on physician quality, based on a recent study.

Transparent information is available for only 16 percent of clinicians on average, according to the report. There is no data available in some states.

The report, available here, indicates that transparent quality data is available for only 12 percent of New York clinicians, 4 points below the national average. Factors such as the availability and understandability of the data were also considered in the final grade. New York scored an 8 overall, compared to Massachusetts' 40 and California's 52.

SUNY Foundation to Pay $4 Million for Falsifying Medicaid Data

From John O'Brien at Syracuse.com:

An agency tied to the State University of New York has agreed to pay the federal government $3.75 million to settle claims that its employees doctored audits to hide the number of ineligible people receiving Medicaid benefits.

Federal prosecutors accused the Research Foundation of SUNY of falsifying its audits of how efficiently the state was running its Medicaid program between October 2007 and September 2008.

Read the full article on the Syracuse.com website.

December 15, 2014

New York Health Centers Net $2.8 Million in ACA Grants

The U.S. Department of Health and Human Services announced the award of $36.3 million in Affordable Care Act funding grants, $2.8 million of which went to 56 health centers in New York. The largest grant of $158,000 went to Bronx Lebanon Integrated Service System, Inc. (BLISS), a nonprofit health center organized in 1996 to provide medical, dental, social, and substance abuse services primarily to residents of the south and central sections of The Bronx. To see all of the New York health centers receiving funds, visit the listing on HRSA's website.

Insurance Circular Letter on Coverage of Gender Dysphoria

The New York Department of Financial Services has issued a circular letter to provide guidance regarding health insurance coverage for the treatment of gender dysphoria. The circular letter summarizes itself:

An issuer may not deny medically necessary treatment otherwise covered by a health insurance policy or contract ("policy") solely on the basis that the treatment is for gender dysphoria. Further, an issuer is required to provide an insured with the full range of utilization review appeal rights as described in Article 49 of both the Insurance Law and the Public Health Law (collectively, "Article 49") for any gender dysphoria treatment that is denied based on medical necessity.

The letter further provides this definition of gender dysphoria: ""Gender dysphoria" is the term currently used for the condition of people whose gender at birth is contrary to the one with which they identify." Read the full letter on the DFS website.

December 12, 2014

Gilead Sued Over Hepatitis-C Drug Pricing

In a case that will assuredly be watched very carefully, the Southeastern Pennsylvania Transportation Authority (SEPTA) has sued drugmaker Gilead Sciences, Inc. over the pricing of its Hepatitis C drug Solvadi®. SEPTA claims that Gilead's patent rights "do not translate into a license to price gouge consumers, state and federal health and welfare programs, and other third party payers under the extraordinary circumstances presented here."

The Pennsylvania Record has a nice writeup here. Link to the complaint here courtesy of the Washington Post.

The class action complaint alleges (among other things) that a standard 12-week regiment of Solvadi in the United States costs $84,000, while the same drug sold in Egypt costs $900.

December 3, 2014

CMS Proposes Revisions to ACO Regs

The Centers for Medicare & Medicaid Services (CMS) has informally posted proposed revisions to the Medicare Shared Savings Program including provisions relating to the payment of Accountable Care Organizations (ACOs). The formal comment period for the revisions will not begin until the regulations are actually published in the Federal Register. Read the proposed regulations here.

Update December 12, 2014 - The regulations were published in the December 8, 2014 Federal Register. Read the regulations here. Comments are due no later than February 6, 2015.

August 31, 2012

More than $2 Million Awarded to New York State Health Care Providers to Address Doctor Shortages


On August 30, 2012, the New York State Department of Health (DOH) announced "Doctors Across New York" (DANY) program grants to 21 hospitals, health centers, medical practices, and physicians for physician recruitment in underserved areas of the state. The grants, totaling $2,052,383, ranged from $65,377 for Bianca D. Van Kust, M.D. in Manhattan to $200,000 for The Woman's Christian Association in Chautauqua. Other recipients include St. Barnabas Hospital in the Bronx, Adirondack Medical Center in Essex County, and Oneida Health Systems in Oneida County.

Read the press release from DOH, with more information about the DANY program and a full list of award recipients and grant amounts, here.

August 24, 2012

DOH's "Get-Tough Approach" to Medicaid Managed Care Plans


A recent Businessweek article examined New York State's approach to improving the quality of care provided by Medicaid managed care plans such as WellCare. In the article, Jason Helgerson, the state's Medicaid Director, elaborates on DOH's enforcement strategy. The article highlights the predominance of not-for-profit plans, payments for good performance, and the state's 85 percent MLR requirement for Medicaid managed care plans as reasons why New York is succeeding where other states have not.

For those of you with experience representing Medicaid plans in New York as well as other states, how does DOH's approach to quality compare to the approach taken by other states?

For additional posts, see the archive headings in the right hand column.