Chapter Leaders Meet With Acting NYS Health Commissioner Zucker
On Monday, July 14th, Chapter Leaders met with New York State Acting Health Commissioner Howard A. Zucker, MD, JD in his Manhattan offices. Those attending presented a brief overview of the Chapter's mission and focus on physician education, advocacy and quality improvement/patient safety. Dr. Zucker briefly addressed his vision for the future of healthcare in New York and discussed at length his concerns over physician workforce capacity in the area of primary care and general internal medicine. The Chapter was asked to prepare a list of options that could assist the Commissioner as he seeks ways to build and maintain physician capacity, with some emphasis on ways to support small practices.
Mandatory Electronic Prescribing Effective March 27, 2015
Amendments to Title 10 NYCRR Part 80 Rules and Regulations on Controlled Substances have been adopted and became effective as final regulations on March 27, 2013. The amendments authorize a practitioner to issue an electronic prescription for controlled substances in Schedules II through V and allow a pharmacist to accept, annotate, dispense and electronically archive such prescriptions.
The amendments require the following;
- Computer applications utilized must meet federal security requirements.The federal requirements are included in the Drug Enforcement Administration Interim Final Rule regarding Electronic Prescriptions for Controlled Substances. The rule may be accessed via the U.S Department of Justice DEA Office of Diversion Control website. Contact your software vendor to determine if your application meets the above mentioned requirements.
- Computer applications meeting federal security requirements must be registered with the Department of Health, Bureau of Narcotic Enforcement.
- To meet the New York State Public Health Law data submission requirements for electronic prescribing of controlled substances, the pharmacy must submit controlled substance dispensing data to the Department of Health, Bureau of Narcotic Enforcement, using the American Society for Automation in Pharmacy (ASAP) format Version 4.2 or greater.
- Pursuant to Public Health Law section 3302(37), an electronic prescription for controlled substances may only be issued in accordance with Department of Health regulations, as well as NYS Education Department regulations and federal requirements. NYS Education Department regulations may be accessed electronically.
New York State Regulations related to Electronic Prescribing of Controlled Substances may also be accessed electronically. Specific regulations pertaining to issuing electronic prescriptions for controlled substances may be accessed in 10 NYCRR 80.64
By March 27, 2015, all prescriptions (including prescriptions for non-controlled substances) issued in New York State must be electronically transmitted, with certain limited exceptions. Please continue to visit this webpage for information pertaining to electronic prescribing of controlled substances.
If you have met all federal security requirements and would like to register the application with the Bureau of Narcotic Enforcement, send an email to firstname.lastname@example.org. Include "Electronic Prescribing" in the subject.
- Letter to Pharmacies Regarding Electronic Prescribing Registration
- Letter to Practitioner Regarding Electronic Prescribing Registration
New York State HIV Testing Law Updates
There are over 10,000 people living with HIV in New York State that are unaware of their HIV status. In 2010, Article 27-F was amended to require that HIV testing be offered to all persons between the ages of 13 and 64 receiving hospital or primary care services with limited exceptions, and included a requirement for written, informed consent except in the case of rapid testing. The Centers for Disease Control and Prevention (CDC) recommends routine HIV screening in healthcare settings. Before the 2014 amendment was passed, New York State was only one of two states in the nation to have laws inconsistent with this federal guidance. Removing the requirement for written consent eliminates a barrier to expanded testing by identifying more individuals and linking them to care and treatment. Use this link Regional Stakeholders Handout to review the guidance and New York State Law references, and for a simple, easy to use one-page reference guide:
Changes to Simplify HIV Testing Consent and Improve Linkage to Care
Active Bills - Last Week of Legislative Session:
While there are many, many bills active at this point, today is the final day of the scheduled legislative session. Following is a brief highlight of three very active health issues as session draws to a close. A full report will be posted to our website recapping major health legislation after session has concluded.
Lyme Disease - A full press conference on June 18, 2014 highlighted a report just issued by the Senate Majority Coalition Task Force on Lyme and Tick-Borne Diseases. The legislation which had been recently amended, was passed by the Senate later last night and would exempt from professional misconduct the provision of a treatment modality by a licensee that is not universally accepted by the medical profession, including but not limited to, varying modalities used in the treatment of Lyme disease and other tick-borne diseases. The legislation that had previously passed in the Assembly has now been amended to match this version and may be on the Assembly Calendar today. If passed, it will then be sent to the Governor for his signature. The Chapter has worked with many other professional associations including MSSNY, AAFP and AAP to closely monitor this bill.
Medical Marijuana - An amended version of the Compassionate Care Act was submitted in the Assembly and Senate before midnight on Monday evening, enabling it to be voted on by Thursday's final day of the legislative session. While the new version incorporates some of the changes recommended by the Governor, no final agreement has been reached as we go to print. Still, the Governor indicated he is open to using a message of necessity, which would allow lawmakers to vote on a bill without the usual three-day waiting period if a three-way agreement can be reached. The latest version of the bill eliminates several conditions from the list for eligibility: lupus, post-concussion syndrome and diabetes. It also bans smoking in public, and eliminates a regulatory advisory board. The bill allows smoking of marijuana by those older than 21, a concern of law enforcement and Health Department officials. Yesterday, advocates for the Compassionate Care Act were clearly visible at the Capitol.
- Heroin-Opioid Addiction - An agreement has been reached on a package of legislative bills that includes new programs and insurance reforms to improve treatment options for individuals suffering from heroin and opioid addiction, measures to strengthen penalties and put in place additional tools for law enforcement to reduce the distribution of illegal drugs, provisions to ensure the proper and safe use of naloxone and support for increased public awareness campaigns. This package builds upon the adoption last year of the ISTOP Act where physicians must check a statewide database before issuing a prescription for controlled substances.
Governor Andrew Cuomo's Budget Proposals Related to Healthcare
Following are highlights of some key 2014-2015 proposed budget issues that the Chapter will actively follow.
Continuation of funds for Doctors Across New York (DANY)
DANY is a State funded program that supports physicians who choose to practice in underserved areas in New York. Loan repayment and/or funds to help establish a practice have been available. We strongly support initiatives to increase access to care for patients by expanding the physician workforce. The continuation and expansion of funding for this program is a top priority for the Chapter.
Out of Network Coverage
This budget provision seeks to enhance transparency of health coverage by including a proposal to regulate billing, reimbursement, physician and health care plan disclosures to consumers for health care services
provided to patients by “out-of-network” providers who do not participate in a patient’s health insurance plan.
Funding to promote Health Information Technology (HIT) connectivity through the State Health Information Network (SHINY)
The Department of Health is working to create a “pipeline” through which patient information can be safely transmitted from different regions across the state to improve patient care and allow providers access to important health information across all provider settings. $65 million in State funds is allocated for digitizing health records. By linking an All Payer Claims Database, which includes private payer and Medicare/Medicaid data, with EMR and public health records through a state supported infrastructure, NYS is working to improve clinical outcomes and overall health.
Establishment of Limited Service Clinics within Retail Spaces
This provision in the budget would allow for private businesses like CVS and Wal-Mart to establish for profit retail health clinics potentially staffed by Nurse Practitioners. The law includes no limitations on self-referrals (similar to requirements for private physician practices) meaning patients may use an onsite pharmacy in close proximity to other store products to increase profits. NYACP does not support this proposal that changes long standing “corporate practice of medicine” definitions and prohibitions.
Changes to Nurse Practitioner (NP) Collaboration
Alterations to the current regulations related to Nurse Practitioners could allow for NP’s with more than 36 months of practice and 3600 hours to work under a collaborative relationship with a hospital rather than in collaboration with a specific Physician. In addition, NP’s who have had their collaborative agreement with a physician terminated by physician relocation, retirement or death will be allowed to practice for up to 6 months under an NP of the same specialty who has over 3600 hours of experience until a new practice collaboration agreement with a physician can be achieved.
Excess Medical Malpractice Insurance
The second layer of medical liability coverage (accessed through hospital privileges) has been extended to 6/30/15.
Extension of HCRA which funds Hospitals and supports “public good programs” including GME
The Health Care Reform Act, which was set to terminate in March of this year, will be extended into 2017 in order to continue to provide services spanning many different areas of health care including workforce, hospital financing and GME training. HCRA also helps hospitals to negotiate rates with third party payers. A new addition has been proposed to the HCRA line and is mentioned in Health Information Technology section above.
This provision eliminates the separate written consent for HIV testing by a patient or health care proxy. The person ordering the test must advise the individual that an HIV related test is being performed and this notification shall be noted in the patient’s health record. New York and Nebraska are the only states who have continued to require written consent for HIV testing.
Certificate of Need Redesign
The process for undertaking limited construction projects for hospitals and diagnostic and treatment centers has been streamlined without regard to public need under certain circumstances. Also, the Commissioner of Health will issue new regulations to approve and issue operating certificates to open primary care facilities. In addition the “look back period” for approval has been reduced from ten to seven years. Also, there will be increased transparency with regards to transfer of ownership of these facilities. Disclosure of information will be required if over 10% of an operating facility’s worth is being transferred.
Elimination of IPRO resident work hour audits
The Accreditation Council for Graduate Medical Education has been tracking work hours of residents across the country, and the IPRO audits conducted by the State are now a duplication of this. Elimination of the regulation, which was made effective prior to ACGME tracking, will create savings to the State.
Definition of Urgent Care
The Executive Budget reflects recommendations of the Public Health and Health Planning Council and will restrict the use of the name “Urgent Care” to only those providers that meet specified criteria, including minimum scope of services requirements, as defined by the Department of Health.
Office Based Surgery
Office Based Surgery (OBS) and Office Based Anesthesia (OBA) will have more stringent accreditation processes and a more comprehensive reporting requirement for adverse events under the proposed budget provisions. The legislation suggests including podiatrists, monitoring of procedure and recovery times and requires registration and data submission of practices providing OBS and OBA.
Cancer Detection and Education Advisory Council
This provision consolidates funds for cancer research and advocacy groups to include additional cancer diagnoses. Also, the “Breast, Cervical and Ovarian Cancer Detection and Education Program Advisory Council” will be renamed to the “Cancer Detection and Education Advisory Council”. The provision adds colon, prostate and testicular to the list of cancer types on which the Board may advise.
Tax Requirements for Licensure Requests or Renewals
This provision would limit an individual who has an outstanding tax liability from obtaining an occupational, professional or business license and provide the State with means to enforce delinquent tax liabilities against an individual applying for or renewing such licenses.
"Doctors Across New York" - Vital Program for our Future
NYACP sponsored visits at the State Capital along with representatives from several other state healthcare organizations as part of the WAG (Physician Workforce Advisory Group) to inspire support for continued and expanded funding of DANY (Doctors Across New York). DANY award recipients were present to tell their real life story of how they settled into a community and began their medical career with the assistance with this vital state funded program. DANY was established to promote recruitment and retention of physicians providing care to underserved populations in New York. We met with State Senators and Assemblymen to discuss the benefits of a strong primary care foundation in the State and the dialogue was very productive. Legislators were actively engaged about the looming physician shortage, especially in primary care, the increase in insured patients due to the New York's Health Benefit Exchange and the need for a solid primary care workforce to keep New Yorkers healthy. In addition to DANY, the WAG also promoted the continued funding of the PCSC (Primary Care Service Corps) to support the growth of allied health providers to increase effective care teams.
The DANY program has allocated more than 34.2 million dollars to more than 100 award recipients. Continuation and expansion of this program is a priority legislative goal.
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