Capital Update May 15, 2026
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Despite widely publicized promises made last summer by more than 60 health insurers — including UnitedHealthcare, Aetna, Cigna, Humana, Elevance Health, and Blue Cross Blue Shield Association plans — to voluntarily reform the prior authorization process by reducing barriers to patient access and easing long-standing administrative burdens on physicians, new data released by the American Medical Association (AMA) this week shows that physicians remain skeptical, reflecting years of unfulfilled commitments. Several targeted reforms were proposed in this year’s Executive Budget, along with comprehensive legislation sponsored by Assemblymember David Weprin and Senator Gustavo Rivera. MSSNY has urged that the State Legislature and Governor include needed reforms in the FY2026-27 State Budget.
Prior authorizations place overwhelming burdens on physicians and create unnecessary delays in needed patient care. Delays in the authorization of prescriptions, tests, or procedures can cause needless anxiety for patients already coping with uncertainty about their condition, while also undermining physicians’ clinical expertise in treating their patients. To that end, the AMA survey highlights that health insurers’ prior authorization requirements result in:
- Delayed Care. 95% of responding physicians report that prior authorization delays access to necessary care.
- Poor Outcomes. 92% say prior authorization negatively affects clinical outcomes.
- Disrupted Care. 79% report that patients abandon treatment because of authorization challenges.
- Patient Harm. 26% report that prior authorization has resulted in a serious adverse event, including hospitalization, permanent impairment, or death.
MSSNY will continue to urge lawmakers to include needed reforms as part of the final enacted State Budget.
The State Legislature and the Governor are closing in on a final agreement on the State Budget, with the Assembly Speaker noting that bills may very well be considered next week. In this regard, it is imperative that physicians immediately communicate 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.
Urge Your Legislators to Reject Steep Increases in Medical Liability Costs.
Please urge the Legislature to reject 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. Reject Physician Cost-Share.
Urge Your Legislators to Protect Access to a Fair Dispute Resolution Process.
Please urge the rejection of the Executive Budget 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. Protect Fair IDR Process.
Urge Your Legislators to Preserve Physician-Led Team Care.
Please urge the rejection of the Executive Budget proposal to permit Physician Assistants (PAs) to practice without any defined physician supervision after 8,000 hours practice, despite a law enacted in 2025 giving PAs significantly more care responsibilities. Preserve Physician-led Care.
Urge Your Legislators to Preserve County Medical Society Peer Review.
Please urge the rejection of the Executive Budget proposal to eliminate the historical vetting role of the county medical society in recommending physicians to participate in the Workers’ Compensation program. Preserve Workers’ Compensation Peer Review
Urge Your Legislators to Enact Meaningful Reduction in Prior Authorization Hassles. Support Prior Authorization Reform
As noted above, please urge the inclusion of 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.
Legislation (A.8849-B, McDonald/S.9401-A, Rivera) has passed both the New York State Assembly and State Senate supported by MSSNY that would require the New York State Department of Health to enable the state’s I-STOP prescription monitoring database to become interoperable with physician electronic health record systems.
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 electronic health record (EHR) systems. This deficiency forces 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 administrative burdens on physicians and their staff while increasing the checks to the I-STOP database.
The bill will be delivered to the Governor for her consideration later this year.
Legislation (A.1206-B, Kim/S.634-B, Liu) has passed both the New York State Assembly and State Senate supported by MSSNY that would ensure that health insurance plans cover diabetes and prediabetes screenings pursuant to national evidence-based screening guidelines.
Dr. Charles Lopresto, Vice-Chair of MSSNY’s Legislative & Physician Advocacy Committee, and Dr. Inderpal Chhabra, MSSNY Commissioner for Continuing Medical Education, participated in a press conference in Queens with the bill sponsors last spring to urge passage of the bill.
This legislation would take an important step towards addressing disparities in diabetes and prediabetes diagnosis and care, particularly among some communities that have historically experienced limited access to preventative health services and which have been underserved by treatment coverage policies. As an example, the American Diabetes Association (ADA) recently revised their diabetes testing guidelines to recommend that patients of Asian American or Pacific Islander descent be tested if their body mass index is 23 or greater, as compared to 25 for the rest of the population. The Centers for Disease Control and National Institutes of Health have made similar recommendations.
The bill will be delivered to the Governor for her consideration later this year.
