Capital Update June 5, 2026
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Nearly two months after it was due and just one week prior to the end of the 2026 Legislative Session, the New York State Legislature and Governor completed passage of a $268.5 Billion State Budget for the 2026-27 Fiscal Year. This Budget cycle was particularly challenging this year given the extraordinary volume of issues impacting physician-delivered care under discussion.
As noted last week, the final Budget includes positive prior authorization reforms, new Medicaid funding for the physician fee schedule, a continuation of important programs, and a rejection of several physician-opposed measures. However, it also contained profound changes to New York’s surprise bill law particularly as it relates to publicly funded health plans, despite repeated warnings from MSSNY and other groups regarding the impact of such a step on hospital emergency departments across the State that rely upon on-call specialty physician care.
Some of the Positive outcomes for Physicians in the Budget included:
- Rejection of the proposal opposed by MSSNY to require physicians to bear 50% of the cost of the Excess Medical Malpractice Insurance coverage, saving physicians nearly $40 million.
- Rejection of the proposal opposed by MSSNY to enable many Physician Assistants to practice without physician supervision.
- Rejection of the proposal opposed by MSSNY to reduce the pass-through entity tax credit used by many private physician practices
- Prior authorization reforms supported by MSSNY:
- Increased health plan reporting on pre-authorization requests approved and denied, including the 25 most frequent CPT codes where a pre-auth was requested, and the 25 most frequent CPT codes where a pre-auth was denied.
- Ensuring 90 days of continued coverage for a course of treatment by a non-par physician when the patient enters a new health plan.
- Greater health insurance transparency of their prescription formularies, which must be available on health plan websites without having to establish an account or password.
- Prohibit prior authorization more than once per year for an outpatient course of treatment (including prescription medications) for a chronic health condition starting from the date of a pre-authorization approval for the course of treatment.
- Continuation of Requirement for Health Insurers to ensure telehealth payment parity.
- Allocation of $50 million in new funding for the Medicaid physician fee schedule.
- Funding of the Doctors Across New York medical student loan repayment program, MSSNY’s Committee for Physicians’ Health program, and the MSSNY/NYSPA/NASW Veterans’ Mental Health Training Initiative at historical levels.
- Reducing prior authorization requirements in Workers’ Compensation by increasing cost of care threshold from $1,000 to $1,500.
Adverse and Profound Changes to IDR Will Impact Hospital Emergency Departments. Despite the pervasive opposition from MSSNY and other physician and hospital groups, through legislative advocacy in the Capitol, physician grassroots efforts and numerous media pieces, the State Budget includes a comprehensive component significantly reducing access to and awards from New York’s Independent Dispute Resolution (IDR) process. The new provisions do not change current statutory IDR criteria for out of network disputes involving state-regulated commercial plan enrollees. HOWEVER, the new provisions greatly limit physician appeal rights by:
- Removing Medicaid Managed Care out of network claim disputes entirely from IDR. Became effective upon Governor’s signing on May 28.
- Bringing NYSHIP/Empire Plan into state IDR but under a different decisional standard. Disputes involving out of network NYSHIP claims will be decided by proximity to a 50th-percentile “allowed amount benchmark” rather than the existing statutory criteria. There will be an opportunity to ask for the IDRE to look beyond proximity to the 50th percentile benchmark, but the upper ceiling for such awards still capped at an 80th-percentile “allowed amount benchmark”. Becomes effective 90 days after signing – August 25th.
- Establishing situations where IDR will not be available as a remedy regardless of insurance coverage:
- if the health plan can demonstrate that it has a contract with the provider or a subsidiary or other entity owned or operated by the provider that is in effect at the time the disputed service or services were provided to provide the same service or services at the same location; or
- If the health care plan can demonstrate that a notice of determination for prior authorization has been issued to the patient’s health care provider that includes necessary legal disclosures and clearly identifies the health care service or services in dispute as out-of-network.
MSSNY will continue to work with allies to advocate for legislation to reverse these changes, to obtain answers to questions regarding implementation challenges including applicability of various effective dates and assessing various legal options for physicians.
Workers’ Compensation Changes Impact County Medical Societies. The final State Budget also established a “universal approval” system for physicians to participate in the Workers Compensation program, which eliminates the long-standing requirement for a physician’s initial application to include a recommendation from the county medical society where the physician practices. While lauding the intent to increase physician participation in the WC program, MSSNY and county medical societies across the State raised serious concerns because, in addition to eliminating an important credentialing process applicable with other forms of insurance, the Budget measure does very little to address the litany of claims administration and payment hassles that currently and will continue to deter physicians from participating in the WC program. The changes will take effect January 1, 2028.
We thank all the physicians and county society leaders who took the time to make a phone call, send a letter or tweet, and/or come to Albany to advocate on all these items on behalf of their colleagues and patients.
Legislation (A949, Lunsford/S.998, Brouk) supported by MSSNY passed both the Senate and Assembly to allow for care for mental and behavioral health issues using Telehealth under the workers’ compensation program. It will be delivered to the Governor later this year for her consideration.
This bill expands access to mental health and behavioral services for patients under the Worker’s Compensation program by requiring coverage for telehealth visits for psychological testing, treatment, and counseling by psychiatrists, psychologists, and licensed clinical social workers provided one in-person visit occurs within twelve months of the first video telehealth visit and within six months of the first audio-only telehealth visit if recommended by a healthcare provider.
This legislation builds on several different measures enacted recently to expand coverage for telehealth-delivered healthcare services by physicians and other healthcare providers. This bill is critically important as it will enable injured workers to obtain their necessary treatment via telehealth while still requiring an in-person visit when recommended by their physician or other care provider.
MSSNY collaborated with numerous specialty societies this year to protect patient safety by successfully advocating together in opposition to numerous bills under very serious consideration that would have significantly expanded the scope of various non-physician care providers. We very much appreciate assistance from the American Medical Association including a grant for media advocacy from the Scope of Practice Partnership. Among the most notable of these measures:
Legislation, both stand-alone (A.7988/S.7981) and in the State Budget, which would have permitted many physician assistants to practice without physician supervision after 6,000 hours.
- Legislation (A4706C/S5860C) which would have greatly expanded the scope of services that could be provided by chiropractors, including care typically provided by neurologists, orthopedic surgeons, and radiologists.
- Legislation (S357B/A6771A) which would have permitted Nurse anesthetists to practice without appropriate physician supervision.
- Legislation (S263/A2308) which would have permitted psychologists to prescribe medications.
- Legislation (S352/A9148) which would have permitted physician assistants to perform fluoroscopy.
The Session ended with neither the Assembly nor the Senate taking up legislation (A.11340/S.10171) strongly opposed by MSSNY and many other groups that would have significantly increased liability insurance costs through changes in the types of damages awardable in wrongful death actions. Similar legislation had passed the State Legislature in each of the last four years but was vetoed by Governor Hochul after substantial advocacy by groups representing physicians, hospitals, municipalities, businesses and insurers. MSSNY will continue to work with policymakers to enable comprehensive reform of New York’s dysfunctional medical liability adjudication system, which has led to New York physicians facing the highest medical liability premiums in the country.
In the Session’s final days, MSSNY worked with the American Academy of Pediatrics to collectively oppose well-meaning but overbroad legislation (A.10421A/S4903B) that would have required physicians and other care providers treating a minor patient with a condition “that may create a disability” to provide information to such patient that the patient is entitled to a “free and appropriate education”. The bill passed the Senate but not the Assembly.
MSSNY and AAP expressed concerns that the cohort of patients who qualify as “having a medical condition that may cause a disability” under the federal rehabilitation act was far too broad, which would have presented a significant challenge to physician practices treating pediatric patients regarding which patients should receive this notice, with the risk that failure to provide such notice will result in a sanction from the Department of Health. Moreover, the bill did not adequately specify the manner by which the physician will be required to provide the link to be developed by DOH. At a time when New York State is already struggling to keep physicians due to its ranking as THE WORST state in the country in which to be a physician, and a time when physicians are already drowning in excessive administrative requirements, the threat of sanctions for failure to comply would further discourage physicians from practicing in New York State.
The Senate and Assembly passed legislation (A8460/S2393) that would require health care providers seeking to store patient credit card information to obtain express consent from the patient. MSSNY and the North East Regional Urgent Care Association expressed support for the intent of the legislation to protect against unauthorized use of a credit card, but also serious concerns that the bill as written may impose significant operational burdens on small community-based medical practices, creating an additional obstacle to collecting legitimate patient balances not otherwise covered by the patient’s insurance. Therefore, our groups will be requesting a veto or chapter amendments to this bill when it is considered by the Governor.
MSSNY’s memo on the legislation noted that this legislation is duplicative of other state and federal statutes. These include GBL Section 519-a, enacted just a few years ago that already prohibits a health care provider from requiring a patient to have a “card on file”, as well as the federal Fair Credit Billing Act and Payment Card Industry (PCI) Data Security Standards governing how health care providers store payment information. The memo also noted that it is often unclear at the time when the patient is in the office whether a service may be covered, or what the patient cost-sharing will be. If a consent form is not signed, or an incorrect form is used, it will greatly reduce the ability of the provider to recover the appropriate payment for the service from the patient after they have left the office.
The Senate and Assembly passed legislation (A.11328/S.10340) which would add Alpha-Gal syndrome to the list of dozens of other communicable diseases requiring physicians and other practitioners to report a patient diagnosis to a county health department. Alpha-gal syndrome is a condition caused by the bite from a Lone Star tick which is prevalent across New York State.
MSSNY continued in its advocacy efforts in the Legislative Session’s final days to strengthen protections for physicians facing arbitrary insurer contract non-renewals. Following extensive negotiations, modified legislation (S.1911C, Rivera) to provide a meaningful opportunity to challenge these non-renewal determinations passed the Senate this week. The latest version of this bill would require:
- Health plans to provide written notice of nonrenewal that includes a clear explanation of the determination, with specific reasons for the decision.
- The notice of non-renewal to include instructions on how the physician may submit information in response to the stated reasons.
- The notice of non-renewal to include instructions regarding the process for requesting reconsideration of the determination by the health plan.
As of this writing the bill was still awaiting a vote in the Assembly. If it is not passed, MSSNY will continue to urge that it be taken up if the Legislature were to return to Albany later this year. Please remain alert for further updates on this legislation.
On the heels of the legislation recently signed into law to ensure the continued availability and coverage for vaccinations using standards established by the New York State Commissioner of Health, the Senate and Assembly have passed A.9140 (Rosenthal)/S.9604 (Hinchey), legislation supported by MSSNY which would guarantee continued liability protection for physicians and other healthcare providers who administer vaccinations to their patients. The bill will be sent to the Governor later this year.
Current federal law protects healthcare providers from liability when they provide vaccinations consistent with the guidelines of the Advisory Committee on Immunization Practices (ACIP), provided there is no gross negligence or willful misconduct. However, given recent changes to ACIP guidelines to limit certain vaccines that are at odds with the recommendations of well-respected medical organizations, some states, including New York, have sought to create their own vaccine guidelines that are consistent with these recommendations. This bill would also help to maintain existing liability protections when New York State specifically establishes its own vaccination guidelines.
Earlier this year, a law was enacted effective August 5, 2026, that permits a physician to prescribe medication to a patient with a terminal condition to enable the patient to end their life, also known as the Medical Aid in Dying (MAID) law. This week, the New York State Department of Health proposed regulations requiring the attending physician who chooses to prescribe such medication to report numerous details to DOH within 5 days of issuing the prescription.
By way of background, the MAID law requires that the attending physician choosing to write such a prescription make a determination that the patient has a “terminal illness or condition” meeting the statutory definition and that such patient made a voluntary, informed decision to request such medication. A terminal illness or condition means “an incurable and irreversible illness or condition that has been medically confirmed and will, within reasonable medical judgment, produce death within six months whether or not treatment is provided.” A second, consulting physician must confirm that the patient has a terminal illness or condition and has made a voluntary, informed decision to request medication for MAID. Both the attending physician and the consulting physician must document that the patient has decision-making capacity, with a third practitioner, who must be a mental health professional, to also determine that the patient has decision-making capacity.
In addition, the patient wishing to receive such medications must be a New York state resident age 18 or older, must be witnessed by two individuals who do not have a financial interest in the estate of the patient, and must be recorded by audio or video. The medication must be for patient self-administration, and the prescription cannot be filled until 5 days after it is written.
The DOH regulations would require that the information to be reported to DOH include:
- A unique patient identifier, in a format specified by DOH and the name, practitioner license title, and New York State practitioner license number of the attending physician, consulting physician, and mental health professional.
- The terminal illness or condition for which the medication was prescribed.
- The information included in the prescription, including the names of the medications, the strength and dosage form, and an affirmation that the prescription contained a notation to prevent the prescription from being filled until five days after the prescription was written.
- The age of the patient at the time the medication was prescribed to the patient.
- The patient’s gender.
- The patient’s care setting (such as facility or private residence) and the county of residence.
- An attestation that the attending physician, consulting physician, and mental health professional who provided medical aid in dying have complied with provisions of article 28-F in a format specified by the department.
We acknowledge that there continue to be legitimate debates within the medical community regarding the moral aspects of this new law. Understanding the need for all physicians to have information about this law, MSSNY will continue to work with DOH to provide important updates on the law’s implementation. In a DOH press release this week, it was noted that comprehensive guidance to this law will be forthcoming.
The New York Workers Compensation Board has proposed regulations to update the process by which an employer or carrier can request a deposition of a treating physician providing medical care to an injured worker following submission of the medical report. Among the several components, the proposed regulations seek to increase the fee paid to a deposed physician from a flat $450 fee to $500 for the first hour of testimony, plus an additional $125 for each subsequent 15-minute increment. It further provides that if the carrier makes payment for the deposition more than 45 days after the deposition, the base fee increases to $700 (plus any additional 15-minute payment adjustments).
The proposed regulations are available here.
U.S. Senator Kirsten Gillibrand announced this week her efforts urging expedited processing, expanded transparency on timelines, and other steps to ensure that International Medical Graduates (IMGs) with contracts in high-need areas can begin work without further delays.
IMGs play a critical role in New York’s healthcare system, comprising more than one‑third of the state’s physician workforce. Hospitals, particularly in shortage areas, rely heavily on the J‑1 visa waiver program, which allows physicians to remain in the U.S. if they commit to practicing in designated Health Professional Shortage Areas.
Senator Gillibrand’s statement raised concerns with the delays in waiver processing at the US Department of Health and Human Services that are disrupting staffing plans and exacerbating existing workforce gaps. A 2025 report cited by Gillibrand found that 16 rural counties in New York face severe access challenges, with some lacking even a single pediatrician or OB‑GYN. On average, these counties have fewer than half the statewide ratio of primary care physicians.
Her statement further noted that the situation is especially urgent for physicians completing residency programs, who face a July 30 deadline to secure waiver approvals or risk returning to their home countries. Hospitals warn that vacancies created by these delays are difficult to fill and carry potential financial consequences, including costly rehiring requirements under federal immigration policy.
Earlier this year, MSSNY’s Council adopted a new policy underscoring MSSNY’s ongoing commitment to strengthening and modernizing New York’s healthcare workforce. With physician shortages continuing to challenge patient access to care across the state, particularly in medically underserved and rural communities, this policy represents a forward-looking step toward utilizing the full breadth of available talent, including expanded use of IMGs.
In this regard, MSSNY continues to work collaboratively with the New York State Legislature and other stakeholders to create alternative pathways for qualified IMGs to enter and contribute to the state’s healthcare system.
