Capital Update April 24, 2026
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Physicians must continue to advocate to their legislators on the several pressing State Budget health care policy issues under negotiation that will exacerbate the significant challenges facing physician care delivery across the State if they are adversely decided. The State Legislature has passed another series of extender bills to keep the State government funded through Monday, April 27th.
Urge Your Legislators to Reject Steep Increases in Medical Liability Costs. Reject Physician Cost-Share.
Both the Senate and Assembly recommended rejection of the Governor’s proposal to impose $40 million in new costs to the 16,000 physicians who receive Excess Medical Malpractice Insurance coverage by requiring them to pay 50% of the coverage cost, despite the fact that they already pay by far and away the highest liability costs in the country.
Urge Your Legislators to Protect Access to a Fair Dispute Resolution Process. Protect Fair IDR Process.
Both the Senate and Assembly recommended rejection of the Governor’s proposal that threatens immediate specialty care availability in Emergency Departments across New York State by upending New York’s innovative IDR payment resolution process for non-participating provider claims, altering the criteria to make it one-sided towards health insurer interests and eliminating ability to appeal out of network Medicaid Managed Care disputes to IDR. Essentially, this would enable the health insurer to “put its thumb on the scale” in what is supposed to be an INDEPENDENT dispute resolution process.
For more information on this issue, please see these op-eds from MSSNY President Dr. Mark Adams PressReader.com and MSSNY Immediate Past-President Dr. David Jakubowicz Newsday.
Urge Your Legislators to Preserve Physician-Led Team Care. Preserve Physician-led Care.
Both the Senate and Assembly recommended rejection of the Governor’s proposal to permit many Physician Assistants (PAs) to practice without any defined physician supervision after 8,000 hours practice, despite a law implemented last year giving PAs significantly more care responsibilities.
Urge Your Legislators to Preserve County Medical Society Peer Review. Preserve Workers’ Compensation Peer Review
The State Assembly recommended rejection of the Governor’s proposal to eliminate the historical vetting role of the county medical society in recommending physicians to participate in the Workers’ Compensation program. Unfortunately, the Senate included this proposal in its one-House Budget proposal as part of a larger reform package that also included measures seeking to reduce some of hassles physicians experience in the WC system.
This proposal would eliminate an important community review role that helps to ensure injured workers are treated by qualified physicians. The problem with Workers’ Compensation is not the application process, but its low payments relative to the enormous hassles of claim submissions and non-payment months and years after providing complex care to injured workers.
Urge Your Legislators to Enact Meaningful Reduction in Prior Authorization Hassles. Support Prior Authorization Reform
The Senate included the Executive Budget proposal supported by MSSNY to: prohibit health insurers from requiring a prior authorization more than once per year for treating a chronic health condition; requiring greater transparency of health plan formularies; requiring greater transparency of prior authorization denials; and to provide a 90-day transition period for a patient to continue to be treated by that patient’s physician if the patient changes their health plan coverage.
The Assembly largely included the Governor’s prior authorization proposal but did include some substantive limitations on the “once per year” limitation, permitting plans to impose additional prior authorization requirements based upon “nationally recognized clinical practice guidelines” for evaluating possible side effects from an approved treatment, or substantive changes in nationally recognized treatment guidelines. MSSNY together with several other groups have expressed concerns these additional provisions could undermine the benefit of this “once per year” rule by empowering health plans to continue to impose unreasonable prior authorization requirements.
At the same time, MSSNY continues to urge that the State Budget include far-reaching prior authorization reform legislation (A.3789, Weprin/S.9651, Rivera – which advanced to the Senate floor this week) that would reduce the time for receiving prior authorization requests and prohibit altogether repeat prior authorization requirements from health plans.
The Assembly passed multiple bills this week to ensure continued access and coverage for needed vaccinations. The first bill (A.10711- Paulin/S.9598- Stavisky) would ensure the continued availability of vaccinations for children and newborns using standards established by the New York State Commissioner of Health, instead of the Advisory Committee on Immunization Practices (ACIP). The standards would be based on widely accepted medical guidelines and take into consideration recommendations from the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Physicians (ACP), and other nationally recognized medical organizations, as well as the ACIP. The second bill (A.10710, Dilan/S.9599, Bailey) would ensure continued health insurance coverage for vaccinations based upon the recommendations of ACIP or the NYS Commissioner of Health, which would also be based on recommendations of AAP, AAFP, ACOG or ACP.
Current New York State law regarding immunization requirements, and medical professionals’ ability to prescribe and administer vaccines, is tied to recommendations made by the federal Advisory Committee on Immunization Practices (ACIP), which makes recommendations regarding immunizations to the Center for Disease Control (CDC). These bills would ensure that various vaccines available in New York State and covered under health insurance are not solely based on ACIP recommendations but also on recommendations of the New York State Commissioner of Health.
Legislation (A.8849-B, McDonald/S.9401-A) was advanced this week from both the Assembly and Senate Health Committees to require the New York State Department of Health to enable the state’s I-STOP prescription monitoring database to become interoperable with various physician electronic health record (EHR) systems. The bill is now before the full Assembly and full Senate. MSSNY has indicated to the Legislature its support for this legislation.
MSSNY has long supported this type of I-STOP-EHR connectivity. For over a decade New York State has maintained a database that prescribers are required to consult prior to writing most patient prescriptions for a Schedule II, III, or IV controlled substance. Unlike most states with similar prescription monitoring databases, New York’s current I-STOP prescription monitoring database is not directly interoperable with the various physician’s EHR systems. This deficiency forces many physicians and their staff to toggle between the I-STOP database and their EHR several times per day at a time when physicians are already drowning in administrative burdens, adding countless additional minutes to each physician’s day to ensure patients can get the medications they need. This legislation would reduce some of these administrative burdens on physicians and their staff while also increasing the availability of information from the I-STOP database to further protect against “doctor-shopping”.
A new, proposed rule from the Centers for Medicare & Medicaid Services (CMS) would require faster prior authorization decisions, expand electronic prior authorization to include prescription drugs, and increase transparency across federal health insurance programs including Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), Qualified Health Plans (QHP) on the Federally-facilitated Exchanges, and Small Group Market QHPs on the Federally-facilitated Small Business Health Options Program (FF-SHOP).
Building on a 2024 CMS rule, which addressed prior authorization for non-medication healthcare services, this proposal creates a streamlined process for medications as is the case with other covered, non-pharmaceutical services. Specifically, the proposed rule modernizes prior authorization for medications by establishing clear deadlines for insurance company decisions of no later than 24 hours for urgent requests and 72 hours for non-emergencies. The proposed policy would also increase transparency by requiring full disclosure of claims denials and appeals outcomes. The proposal also calls for expansion of electronic prior authorization requirements to include medications.
Here is the full statement from CMS.
Here is the CMS Fact Sheet.
When adjusted for inflation, Medicare reimbursement for physician services has declined 33% from 2001 to 2026. Without any action to meaningfully address these staggering cuts, physicians are unable to sustainably run their medical practices and are driven to retire or work for consolidated health systems, private equity, or insurance companies, which results in decreased access in rural and underserved communities.
H.R. 8163 promotes reimbursement stability and protects physicians by: 1) updating the budget neutrality threshold, 2) mandating that CMS evaluate the actual base costs for running a medical practice at least every five years, and 3) revising how CMS addresses incorrect billing codes.
Currently, budget neutrality dictates that if spending increases exceeds $20 million in one area, then that must be offset by other costs in healthcare. The $20 million budget neutrality threshold has remained the same since the early 1990s and has never been adjusted for inflation. H.R. 8163 would modernize this outdated provision, providing a long overdue threshold increase to $54.3 million, and indexing it every five years based on the cumulative percentage increase in the Medical Economic Index (MEI).
This bill requires CMS to regularly evaluate medical practice costs (i.e., clinical wage rates, equipment, medical supplies, etc.) to prevent large swings in payment rates. In addition, H.R. 8163 directs CMS to correct major errors in billing code estimates by reviewing actual claims data and making prospective rate adjustments, thus preventing deep, unnecessary cuts under current budget neutrality guidelines that stem from inaccurate utilization projections.
Make your voice heard: Contact your member of Congress and urge them to support common-sense Medicare payment reforms by cosponsoring this bipartisan bill.
