MSSNY PULSE

Supporting New York’s Patients and Physicians: Response to the Final State Budget

Friday, May 29, 2026

Supporting New York’s Patients and Physicians: Response to the Final State Budget

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Colleagues:

While MSSNY and I are grateful to the New York State Legislature and Governor for several important provisions included in and excluded from the final budget, we are also deeply disappointed by the decisions to eliminate the long-standing county medical society physician vetting role within the Workers’ Compensation system and the significant revisions that will impede access to the Independent Dispute Resolution process.

We appreciate the Legislature’s continued funding of the Excess Medical Malpractice Insurance Program for community-based private practice physicians. This program remains one of the most important physician retention and patient access initiatives in New York State. New York continues to have the highest medical liability insurance costs in the nation, particularly for physicians practicing in high-risk specialties and underserved communities. Without this support, many physicians would be forced to reduce services, leave private practice, retire early, or relocate outside New York State, further worsening physician shortages and threatening access to care for patients who rely upon community-based physicians every day.

We thank the Legislature for continuing its support and funding for the Committee for Physician Health (CPH). The CPH program plays a vital role in protecting patients while supporting physicians facing health challenges, including substance use disorders, mental health concerns, and burnout. By providing confidential assistance, monitoring, advocacy, and pathways to recovery, CPH helps physicians safely continue their professional responsibilities while preserving the integrity of the medical profession and protecting patient safety. Continued State support for this program reflects an important recognition that physician wellness is directly connected to the quality and stability of healthcare delivery throughout New York State.

We also applaud the Legislature for rejecting proposals that would have expanded independent practice authority for physician assistants beyond appropriate physician-led team-based care models. Patients deserve a healthcare system that promotes collaboration while preserving the physician-led standard of care that has long served New Yorkers well. Physicians, physician assistants, nurses, and all healthcare professionals play vital roles in delivering patient care, but the complexity of modern medicine requires the extensive education, training, and clinical experience uniquely provided through physician education, residency training, and continued medical education. Maintaining physician-led care teams helps ensure the highest standards of patient safety and quality care.

Additionally, MSSNY and I want to thank state leaders for continuing to support telehealth parity. Telemedicine has become an indispensable tool in expanding access to care, particularly for patients in rural areas, underserved communities, and for individuals with mobility or transportation challenges. Ensuring fair reimbursement for telehealth services allows physicians to continue investing in technologies and systems that improve patient access, continuity of care, and healthcare outcomes.

We further commend the Legislature for enacting meaningful prior authorization reforms. Excessive and unnecessary prior authorization requirements have increasingly delayed medically necessary care, created significant administrative burdens for physician practices, and interfered with the physician-patient relationship. These reforms represent an important step toward reducing delays in treatment and improving patient access to timely medical care. Physicians should be spending more time caring for patients and less time navigating unnecessary insurance barriers. I will continue to support further reforms on prior authorization, hopefully to be addressed in the next legislative cycle.

Additional items supported by MSSNY and me and included in the budget are continued funding the Doctors’ Across New York physician loan repayment program, providing new funding for the MSSNY/NYSPA/NASW Veterans’ Mental Health Training Initiative, and reducing prior authorization requirements in Workers’ Compensation by increasing cost of care threshold from $1,000 to $1,500. Furthermore, the proposal opposed by MSSNY to reduce the pass-through entity tax credit used by many private physician practices was rejected.

At the same time, we are disappointed with provisions ultimately removed or altered during final budget negotiations. MSSNY and I remain opposed to the elimination of the long-standing physician vetting role performed by county medical societies within the Workers’ Compensation system. For decades, county medical societies have helped ensure the integrity, professionalism, and quality of physicians participating in the Workers’ Compensation program through a trusted peer-review process grounded in local medical oversight and accountability. Removing this important safeguard risks weakening confidence in the system and diminishing the important role organized medicine has historically played in protecting quality patient care.

We are also disappointed by the decision to remove Medicaid claims from the Independent Dispute Resolution (IDR) process, as well as other changes that will significantly limit the ability of physicians to challenge pervasive health plan underpayments through the IDR process. Physicians who care for vulnerable Medicaid patients already face significant financial challenges due to chronically inadequate reimbursement rates. Excluding Medicaid-related disputes from IDR protections risks further destabilizing physician participation in Medicaid networks and may ultimately reduce access to care for many of New York’s most vulnerable populations, particularly in our already overstressed hospital emergency departments that often rely upon the availability of on-call specialty physician care.

As president of MSSNY, I remain committed to working collaboratively with the Legislature, the Governor, and all stakeholders to address the ongoing challenges facing New York’s healthcare system by supporting policies that strengthen patient access to care, support the physician workforce, and protect the health and well-being of all New Yorkers.

All the best,

Mark J. Adams, MD, MBA, FACR
MSSNY President

Capital Update May 29, 2026

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Statement from MSSNY President Dr. Mark Adams – Final State Budget is Mixed Bag for Patients and New York’s Healthcare System

“The agreed-upon State Budget is a mixed bag for our patients and New York’s healthcare system. Importantly, it takes a number of positive steps, including greater transparency of excessive and burdensome health insurance prior authorization requirements that impact our patients’ ability to receive the care they need, ensures for another year full coverage for New York’s Excess Medical Malpractice Insurance program to help mitigate New York’s outrageous liability cost burden for physicians, continues funding for the essential services provided by the Committee for Physicians’ Health, and continues fair insurer payment for delivering healthcare services via telehealth.

“However, we are very concerned about the impact to our state’s hospital emergency departments due to the significant changes to the dispute resolution mechanism that will make it extremely difficult to challenge pervasive health insurer underpayments that could very well deter many specialist physicians from being available on-call to provide immediately needed care to patients. Moreover, we are disappointed that the final package designed to increase physician participation in the Workers’ Compensation system did not include meaningful provisions to address carrier delays in payments for care to injured workers that are the REAL reason physicians are deterred from participating in Workers Comp.

“We look forward to our continued discussions with policymakers to address challenges faced by our patients in obtaining needed care across the State, including finding solutions to address the litany of practice challenges that causes New York to continue to be ranked as one of the worst states in the country to be a physician.”

Budget Passage Includes Several Positive Outcomes for Healthcare, But Massive Changes to IDR Likely to Impact Hospital EDs Across Our State

Fifty-seven days after it was due, the New York State Legislature and Governor completed passage of its $268.5 Billion State Budget for 2026-27. This year was a particularly challenging year given the extraordinary volume of issues impacting physician-delivered care in this year’s Budget discussions.

The final Budget included some prior authorization forms, new Medicaid funding for the physician fee schedule, and a rejection of several adverse proposals opposed by MSSNY. 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.

Positive outcomes 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.
- Prohibiting prior authorization more than once per year for an outpatient course of treatment for a chronic health condition starting from the date of a pre-authorization approval for the course of treatment unless the enrollee’s attending provider recommends a change to 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 MSSNY’s Committee for Physicians’ Health program at $990,000 historical level.
Funding Doctors’ Across New York medical student loan repayment program funded again at $15,865,000 historical level.
New funding for the MSSNY/NYSPA/NASW Veterans’ Mental Health Training Initiative.
Reducing prior authorization requirements in Workers’ Compensation by increasing cost of care threshold from $1,000 to $1,500.

Profound Changes to IDR Will Impact Hospital Emergency Departments. Despite the pervasive opposition from MSSNY and many other allies, through in the Capitol/LOB, in district, grassroots and media advocacy, 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 benchmark” rather than the existing statutory criteria, and IDR awards involving NYSHIP are capped at an 80th-percentile allowed benchmark defined as “maximum fee.” 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.

Workers Compensation Changes Fail to Address Root Cause of What Deters Physicians from Program. Establishing 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.

MSSNY Advocates to Reduce Impact of Health Plan Non Renewals

MSSNY continues 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, legislation to provide an opportunity to challenge these non-renewal determinations (S.1911 C/A.8052 B) was amended this week and remains on the floor in both Houses.

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.

Please remain alert for further updates on this legislation.

Assembly Committees Advance Chiropractic Scope Legislation Opposed by Several Physician Associations

Physicians must continue to contact their legislators to oppose legislation (A4706C/S5860C) that significantly expands the scope of services that could be provided by a chiropractor. The bill presents significant patient safety risks due to its numerous vague provisions, failure to identify appropriate educational standards for ensuring the expanded services can be provided safely, and expanding authorization to conduct detailed diagnostic testing without a defined pathway for treating conditions identified through these tests.

The bill has advanced from the Assembly Higher Education Committee to the Ways & Means Committee. The Senate same-as is currently in the Senate Higher Education Committee but could advance at any time given that the Senate passed a different version of the legislation in the Session’s final days last year. In addition to MSSNY, the bill is opposed by the New York State Society of Orthopedic Surgeons, the New York State Neurological Society, the American Association of Neuromuscular & Electrodiagnostic Medicine, and the American Medical Association. Specifically, the groups’ concerns with this legislation include:

Expanding chiropractic authority beyond the vertebral column to include “other articular segments” and the broad treatment of neuromusculoskeletal conditions without adequate training. Orthopedic surgeons possess years of specialty training including 4 years of medical school, a 5-year residency, all specifically directed at diagnosing and managing pathology of the extremities. By comparison, the standard chiropractic doctoral program has no mandatory post-graduate residency of comparable depth, does not provide equivalent preparation to evaluate and manage structural joint pathology, ligamentous injury, tendon avulsion, articular fracture, or complex instability patterns.
Authorizing chiropractors to perform and interpret electrodiagnostic tests, subject only to departmental approval of vague and unspecified “appropriate education standards.” Electrodiagnostic findings may reveal diagnoses that carry significant implications entirely beyond chiropractic scope. The bill provides no advanced training specific to electrodiagnosis, no competency examination, no mandatory referral obligation, no minimum supervised case volume requirement, and no competency standard. Permitting chiropractors to independently conduct these procedures risks missed diagnoses, delayed treatment of serious neurologic disease, and unnecessary or inappropriate care.
Authorizing chiropractors to order clinical laboratory testing, including methods assessing nutritional and metabolic factors that impact musculoskeletal health, subject to departmental approval. Granting laboratory ordering authority without demonstrating minimal competency or a corresponding framework for managing abnormal results creates a diagnostic gap with potential patient harm consequences.
Fails to identify steps to ensure that chiropractors possess reliably uniform competency for these expanded services. This legislation contains no provision distinguishing practitioners who have pursued rigorous post-graduate training from those who have not, no requirement that expanded diagnostic authority be conditioned on demonstrated specialty competency, and no mechanism for the public or referring providers to ascertain the educational pedigree of the chiropractor performing an electrodiagnostic study or ordering a metabolic laboratory panel.
Defers critical competency determinations to the NYS Department of Education. If a patient is harmed due to a misinterpreted EMG or an unrecognized laboratory finding, the statutory standard is so vague as to provide little meaningful recourse framework.

Again, physicians are urged to contact their legislators to oppose this legislation.

Northwell Health Releases New Toolkit on Firearm Injury Prevention

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Northwell Health’s Center for Gun Violence Prevention released “Guiding Health Systems to Action on Firearm Injury & Violence Prevention.”
The toolkit recognizes firearm injury as a complex public health issue requiring tailored, evidence-based solutions.
Guidance is organized across system-level, community-level, and clinical/organizational strategies to support implementation and scalability.

Physicians and health systems face increasingly complex public health challenges, and turning evidence into meaningful action can be difficult without clear implementation guidance. Healthcare leaders are often asked to address emerging issues while balancing patient care demands, workforce pressures, and operational realities.

Northwell Health, an MSSNY Organizational Member, has taken an important step in this space with the release of “Guiding Health Systems to Action on Firearm Injury & Violence Prevention: An Implementation Toolkit.” Developed by the Northwell Center for Gun Violence Prevention, the toolkit is intended to serve as a practical roadmap for hospitals and health systems seeking to better understand and implement prevention strategies tailored to their communities.

The publication recognizes that firearm injury and mortality are not uniform challenges, and that effective responses require different approaches depending on local needs and patient populations. Northwell notes that while evidence supporting prevention continues to grow, implementation remains the critical gap, and that health systems need practical guidance on execution, sustainability, and scaling successful programs.

Rather than promoting a single model, the toolkit outlines a flexible framework for engagement across three areas:

System-level strategies, including policy, partnerships, and data infrastructure.
Community-level strategies, emphasizing collaboration with local organizations and violence intervention efforts.
Clinical and organizational strategies, such as screening, counseling, hospital-based violence intervention, and workforce safety initiatives.

The resource also focuses heavily on real-world implementation, including leadership engagement, governance structures, funding strategies, evaluation methods, and long-term sustainability planning. Its goal is to help healthcare organizations move beyond discussion and toward operational action.

MSSNY encourages physicians and healthcare leaders interested in prevention, implementation science, and population health to review the toolkit and consider how its lessons may inform their own communities.

Northwell releases first-of-its-kind toolkit to help health care providers implement gun violence prevention programs (Northwell, Libassi, 4/16).

Home, Auto, and Personal Liability Protection for Physicians

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Physicians spend years building their careers, earning potential, and personal assets. Yet many personal insurance programs are assembled gradually over time and may not reflect a physician’s current lifestyle, exposures, or financial position. Reviewing personal insurance periodically is an important part of a broader financial protection strategy, particularly as liability risks and property values continue to evolve.

One area that is often overlooked is liability exposure. Physicians often have greater accumulated assets and future earning potential than the average household. As a result, a serious automobile accident or lawsuit involving a home or recreational property can create significant financial exposure.

For this reason, liability limits on homeowners and automobile policies deserve careful attention. Many individuals carry liability limits that were selected years earlier without revisiting whether those limits remain appropriate. In today’s environment, even a single serious accident can result in damages that exceed policy limits.

Personal Umbrella Liability insurance can play an important role in addressing this concern. An umbrella policy provides an additional layer of liability protection above underlying home and auto policies and may help protect savings, investments, and future income from large personal liability claims. Umbrella coverage is often relatively affordable compared to the amount of additional protection it provides, making it an important consideration. A $1,000,000 umbrella liability limit was once standard, but for most physician households, a higher limit is now more appropriate.

Property coverage is also important. Many homeowners are surprised to learn that rebuilding a home after a major loss may cost substantially more than expected due to increases in construction materials, labor costs, and local building requirements. Periodic reviews of dwelling coverage can help ensure that insurance values are sufficient for current rebuilding costs, particularly after renovations or additions.

High-value personal property is another area that can be unintentionally underinsured. Jewelry, collectibles, artwork, and other valuable items may be subject to limited coverage under a standard homeowner’s policy. Physicians who have accumulated significant jewelry or specialty items over time may benefit from reviewing whether separate scheduling or specialized coverage is appropriate.

In addition, physicians may have exposures that extend beyond a primary residence and personal vehicles. Vacation homes, boats, recreational vehicles, and teen drivers can all create additional insurance considerations that warrant periodic discussion with an experienced agent.

Insurance markets have also become more challenging in recent years, with many carriers increasing premiums or tightening underwriting standards. As a result, proactive communication with an insurance agent has become increasingly valuable. Updating your agent regarding home improvements, alarm systems, roof replacements, or changes in vehicle usage may help identify available discounts or avoid coverage gaps.

Ultimately, personal insurance should evolve alongside an individual’s life and financial circumstances. A comprehensive review with a knowledgeable agent every few years — or after significant life changes — can help ensure that coverage remains aligned with current assets and exposures. For physicians who have worked hard to build financial stability, thoughtful personal insurance planning is an important part of protecting it.

For more information, contact:

Kate Sellers, JD, CLU
President, Sellers Insurance
[email protected];
Tel: 716-627-5400 x 213 Fax: 716-627-5420
www.sellersinsurance.com

Unwind, Connect, and Celebrate at the NCMS Aloha Summer Soirée

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The Nassau County Medical Society invites physicians to the Aloha Summer Soirée on Wednesday, June 24, 2026, from 6:00–10:00 p.m. It will be an evening celebrating community, collegiality, and the relationships that strengthen medicine.