End of the Year Wrap Up

End of the Year Wrap Up

At the end of the year, Governor Hochul took action on a number of bills that had been passed by the NYS Legislature impacting health care delivery in New York where MSSNY had offered comments.

Bills Supported by MSSNY Signed into Law
Importantly, the Governor signed into law several measures that will better ensure that health plans are providing coverage for the treatment and necessary medications recommended/prescribed by physicians for their patients.

• A1741/S5299 – Prohibits the use of “Co-Pay” accumulator policies by health insurance plans, that had prevented patients from applying the value of prescription drug discount cards towards meeting their deductibles. This new law will significantly help patients who are on chronic medication therapies by enabling them to meet their deductibles earlier in a policy year.
• A2085/S906 – Lowers the age to 45 for requiring health insurers to cover colorectal cancer initial and follow-up screening tests
• A5411/S4620 – Requires health insurers to provide network physicians with more efficient “point of care” information regarding health plan formularies and co-pay information through a real-time benefit tool (RTBT)
• A289/S2121 – Takes a number of steps to better ensure health insurers cover the health care needs of medically fragile children
• A372/S5690 – Prohibits health insurers from imposing co-pays for treatment at an opioid treatment program.

Practice Mandate Bills Signed by the Governor Where MSSNY Raised Concerns 

• A273/S4640 – Requires prescribers, prior to prescribing an initial opioid prescription for a patient suffering from neuromusculoskeletal pain, to discuss and consider various non-opioid treatment alternatives (which are specified in the legislation A273 (nyassembly.gov).  The requirement does not apply to prescriptions for patients suffering from post-surgical or cancer pain, or for patients in hospice or receiving emergency care.  The requirement took effect on the day it was signed, December 23, 2022.

It should be noted that the new requirement does overlap significantly with existing NY law requiring the following of “generally accepted national professional or governmental guidelines” in prescribing opioid medications. The recently updated CDC guidelines note that “Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient, and that “Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.”

• A3470/S2521 – Requires health care providers to disclose facility fees not covered by their patients’ health insurance coverage, including by a health care provider who becomes newly employed by a health system.  The new disclosure requirements will take effect on June 21, 2023.  This is the significantly pared down version of the legislation that as originally proposed would have required joint hospital-physician billing.

MSSNY-Supported Bills That Were Vetoed

Unfortunately, Governor Hochul also vetoed bills supported by MSSNY and many other groups that could have reduced the prior authorization hassles experienced by physicians and their patients in health care delivery.

The first vetoed bill (A3276/S5909) MSSNY had supported together with several patient advocacy groups that would have prohibited step therapy/fail first protocols for mental health medications.   The second vetoed bill (A879/S8113) would have prohibited health insurers from denying a claim submission or preauthorization request unless the reviewing physician is in the same or similar specialty as the treating physician.  There was significant back and forth negotiations with the Legislature during the last week of December regarding various proposed amendments from the Governor that could have significantly narrowed the impact of the bill.  But the Legislature rejected these changes as going too far, so the bill was vetoed.  As part of the veto message, the Governor noted that they have “been working with the legislature in good faith in an attempt to reach an agreement to address the problems with medical necessity determinations for all populations in this bill” and that “Given the significant issues this legislation was drafted to address, my hope is to revisit this issue in the upcoming legislative session”.

MSSNY President Dr. Parag Mehta’s statement commenting on the vetoes, as well as urging the Legislature and Governor to focus on advancing legislation that will help to reverse physician burnout trends were covered on 1010 WINS News Radio, in Spectrum News 1 Albany, and Fingerlakes1.com.