Capital Update May 1, 2026
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Negotiations on the top-line issues holding up consideration of the State Budget have accelerated over the past week, pointing towards announcement of a Budget deal soon. In this regard, 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 May 4th.
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 an op-ed from MSSNY President Dr. Mark Adams urging that legislators do not take away physician appeal rights to challenge insurer underpayments.
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.
For more information on this issue, please see an op-ed from MSSNY Immediate Past-President Dr. David Jakubowicz that our patients need and deserve Physician-Led Healthcare.
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 has advanced to the Senate floor) that would reduce the time for receiving prior authorization requests and prohibit altogether repeat prior authorization requirements from health plans.
MSSNY has joined with 15 other medical and dental advocacy organizations in a letter to legislative leaders and the Governor to express opposition to proposals under serious discussion in the State Budget that would significantly alter the Pass-Through Entity Tax (PTET) credit used by many business partnerships and S Corporations, including physician practices.
Specifically, the State Senate one-House Budget proposal contains provisions to reduce the PTET credit to 90% across New York State, and the Assembly one-House Budget proposal contains provisions for the reduction of the PTET credit in New York City, limiting it to 75%. Governor Hochul has expressed her strong opposition to any reduction in the PTET credit.
The current state/local tax structure permits owners of pass-through businesses to claim a federal deduction that is roughly equivalent to the full, pre-cap State and Local Tax (SALT) deduction. Normally, income earned through a pass-through business is taxed directly to the owner on the owner’s individual return. The PTET works by shifting that tax payment to the business level, so that what would otherwise be a capped personal SALT deduction instead reduces the business income passed through to the owner, with the owner then receiving a corresponding state tax credit.
MSSNY and other organizations have raised concerns that the tax change would essentially be causing double taxation, for both the business and personal income tax payments. It would be one more factor accelerating the closure of community-based medical practices, as physicians increasingly find the financial challenges of running a practice leave them no choice but to become a health system employee. The medical and dental associations letter notes that “The proposed reductions, limiting the credit below 100%, would fundamentally alter that structure. What was intended as a neutral, dollar-for-dollar mechanism would instead become a real tax increase on professional income that has already been taxed at the entity level. For the many professionals operating small practices and managing rising equipment and staffing costs, this change would directly reduce the resources available to reinvest in patient care, staff compensation, technology, and community services.”
Please remain alert for further updates
Legislation (A.2613-A) advanced to the Assembly floor this week that directs the New York State Department of Health to develop regulations to require all health care providers, health information networks and Electronic Health Record (EHR) Systems provide patients with the ability to limit disclosure of medical records relating to sensitive health information such as reproductive health care and gender-affirming care. Identical legislation (S.1633-B) is on the floor of the New York State Senate after it was passed but recalled from the Assembly to match amendments made to the Assembly version of bill.
MSSNY has expressed to the bill sponsors, key legislators,and staff its support for the intent of this legislation to help protect health care providers from having civil, criminal, or professional licensing charges brought against them for providing needed care to patients, most notably by out-of-state officials. The legislation has also garnered the support of multiple specialty societies.
However, the letter expresses MSSNY’s significant concerns that certain health care information that may be relevant to a patient’s care may not be available to a subsequent treating physician who may need to know if there is a contraindication with a particular medication or other aspects of a patient’s previous treatment history that could interfere with the treatment being recommended by that physician. In response to these concerns, the bill was amended to create an exception for a “bona fide” medical emergency where a patient is unable to consent. However, this exception does not fully address the litany of medical care situations where prior medical history subject to shielding under this legislation would be relevant to a subsequent treating physician providing care to the patient.
MSSNY also expressed concerns with the challenges that small community-based physician practices may have complying with this legislation, as they may not have sufficient resources to obtain the necessary EHR updates that will be required by this legislation to enable this record segmentation. A measure such as this that could require substantial investment of resources to update EHRs, not to mention the potential legal consequences of failure to comply, might be the last straw for many of these medical practices. The legislation was amended to delay the implementation of this requirement for small practices and to ensure that patient treatment information collected prior to the effective date of the legislation would not be subject to the new requirements. However, these changes do not fully address the significant new costs associated with implementing a potentially complicated EHR change, administrative hassles with ensuring a dual record management system and potentially huge financial penalties if there is any unintended lack of compliance with this legislation.
Please remain alert for further updates on this legislation.
The New York State Department of Financial Services (DFS) Annual Report for 2025 noted that it recovered more than $121 million from insurers of which $72 million was the result of health insurer violations of New York’s Prompt Pay Law. The Prompt Pay Law requires insurers to pay health claims within 30 days for electronic submissions and 45 days for paper submissions. The remaining funds were distributed to New York residents who were owed payments for outstanding health, auto, homeowners and life insurance claims, as well as payments from disputes with banks and mortgage companies.
In 2024, DFS recovered $82 million arising from health insurer prompt payment violations and in 2023 DFS recovered $117 million arising from health insurer prompt payment violations. While this is laudable, it is outrageous that physicians, hospitals, and other care providers must continue to regularly resort to governmental intervention to be paid fairly and accurately for delivering needed patient care, particularly for those physician practices that are hanging on by a thread to continue to deliver essential patient care in their communities.
The problem is that there is little incentive for health insurers to pay claims promptly. New York’s Prompt Payment law, enacted nearly 30 years ago, needs to be updated to increase the penalties and interest that can be imposed on health insurers for illegally delaying payment for health care claims that should be paid pursuant to enrollees’ contract with their health insurer. MSSNY supports legislation such as S.5323, Bailey/A.9265, Solages to update and increase the penalties for the Prompt Payment Law.
On the heels of the Assembly passing legislation (A.10710 and A.10711) last week to ensure the continued availability and coverage for vaccinations using standards established by the New York State Commissioner of Health, this week the legislature passed A.9140/S.9604, which would guarantee continued liability protection for healthcare providers who administer vaccinations to their patients.
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, which is another essential step in ensuring patient access to timely and important vaccinations.
The Assembly same-as to A.10711 (S.9598) has passed the Senate. The Assembly same-as to A.10710 is on the Senate floor, and the Senate same-as to A.9140 (S.9604) is before the Senate Health Committee.
MSSNY will continue to track these important bills and others on this topic as they move through the legislative process.
MSSNY joined with the 110 state and specialty medical associations in a letter initiated by the American Medical Association submitted this week to federal officials to warn about health insurance plans undermining the No Surprises Act and to urge federal regulators to increase enforcement and transparency.
The federal No Surprises Act was designed to protect patients from surprise medical bills and promote fair contracting between payers and physicians by establishing a meaningful dispute process. Most independent physician practices hold little clout in contract negotiations with payers and are struggling for solvency under the weight of low reimbursement rates, increasing prior authorization requirements, and other draining health plan policies. Such challenges are partly responsible for private practices disappearing from the healthcare landscape.
The AMA letter notes that “health plans are finding ways to circumvent the statute with harmful policies that shift costs onto patients and undercut independent physician practices, jeopardizing access to care in their communities.” They asked the departments to use their enforcement authority to rein in several practices that violate the spirit—and the wording—of the law. Among the concerns raised in the letter:
- Inappropriate Cost-Shifting onto Patients. Physicians have heard reports that payers are increasing patient cost-sharing amounts after an Independent Dispute Resolution (IDR) decision in the physicians’ favor—a practice that is clearly in violation of the spirit, if not the language, of the No Surprises Act.
- Misusing Technical Guidance to Reopen Closed IDR Cases. Some health plans appear to be exploiting June 2025 technical guidance intended to allow IDR cases to be reopened in a narrow set of circumstances to reopen final IDR decisions as a way to withhold payment from physicians.
- Ineligible Claims in IDR. Eligibility is often challenging for physicians to determine, especially when it comes to determining the appropriate regulator. Payers possess plan information that makes them best suited to identify eligibility for the process yet often fail to provide necessary information to physicians.
- Lack of Transparency into Qualified Payment Amount Calculations. Physicians report that the calculations do not reflect the market rates for services, as intended under the law. More transparency in how rates are calculated should be required.
- Lack of Timely and Complete Payments. Health plans are failing to reconcile payment outside of the statutory 30-day window, paying only a portion of what they owe, or are not paying at all, often repeatedly and without consequence.
Medical Matters: Post-Viral Syndromes Fireside Chat
COVID may now be an endemic viral disease, but countless people remain burdened by Long-COVID or Post-acute sequelae of SARS-CoV2. There are myriad other post-viral syndromes that need further discussion as well. Be sure to register and join us for a discussion about these post-viral syndromes on April 15th at 7:30a.m. Faculty for this webinar are William Valenti, MD chair of MSSNY Infectious Diseases Committee and Lorraine Giordano, MD, past chair of MSSNY Emergency Preparedness and Disaster/Terrorism Response committee.
Register here
Educational Objectives:
- Identify the multi-systemic clinical features of Long COVID and distinguish them from other post-viral conditions, such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post-Postural Orthostatic Tachycardia Syndrome (POTS).
- Examine standardized diagnostic workup options for patients presenting with persistent post-viral symptoms.
- Develop multidisciplinary treatment strategies that prioritize “Pacing” and symptom management over traditional “Graded Exercise Therapy” (GET), specifically for patients exhibiting Post-Exertional Malaise (PEM).
- Analyze current research regarding the underlying mechanisms of post-viral syndromes, including viral persistence, micro clotting, and immune dysregulation, to better inform patient counseling and participation in clinical trials.
*This program is supported in whole by a DHHS grant entitled New York State Hospital Preparedness Program
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at [email protected]
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
