New York Legislative Update

1
New York Legislative Update

• NYACP Health and Public Policy Committee
• 9.24.08

2
Historic Year for Healthcare Reform

• Physician Medicaid Fee
• Increased up to 75 of Medicare Fee Schedule over
  next two years
• Medicaid Fee Enhancements
• Weekend/Evening Hours
• Diabetes/Asthma Educators
• First step toward shift from inpatient to
  outpatient care
• Doctors Across New York Program
• Loan Repayment Program
• Grants for Practices in Underserved Areas
• Enhanced Funding for Post-Baccalaureate for
  minority and economically disadvantaged students
• 5m to support outpatient residency training
  (including physician offices)

3
2008 Advocacy Day

• Albany
• April 14, 2008
• 14 Attendees
• Access to Care, Patient Safety and Quality of
  Care, Public Health Priorities
• High Level Meetings (ie Commissioner Daines,
  Dennis Whalen, and John Morley)
• Washington DC
• May 14, 2008
• 25 Attendees
• Met with every legislative district in NYS

4
S2790/A4966Practice of Naturopathy

• Bill intended to regulate practice of
  naturopathic doctors through licensure
• Currently Naturopaths are licensed in 15 states
  including Alaska, Arizona, California,
  Connecticut, Hawaii, Idaho, Kansas, Maine,
  Montana, New Hampshire, Oregon, Utah, Vermont,
  Washington D.C., and Washington state
• Allows diagnosis and treatment (inc. prescription
  of nutrients, natural hormones, and antibiotics)

5
NYACP Provisions/Concerns

• Scope of practice too broad. Legislation proposes
  NDs be able to prescribe without adequate
  training nutritional agents, natural elements
  and herbs, natural hormones, local anesthetic,
  and antibiotics
• No clear definition of Naturopathic Doctor (ND)
• They should not use terms physician or
  medicine as it would be confusing to lay
  persons
• Language is vague - Medications such as
  Synthroid, Steroids, Oral contraceptives, human
  grown hormone, various antibiotics, Lidocaine,
  and Digoxin to name a few may fall under this
  scope.

6
Concerns/Provisions cont.

• Naturopaths are ill equipped to manage titration
  and side effects of these medications
• Patient Safety, scope of practice, and access to
  care are main concerns
• STATUS of Bill
• - Senate Third Reading reported to
  Finance (3/28/08)
• - Assembly Referred to Higher
  Education Committee
  (1/09/08)

7
MSSNYs Definition5/29/08

• Definition of the practice of naturopathy. The
  practice of naturopathy by a certified
  naturopathy practitioner involves the application
  of non-pharmaceutical and non-surgical
  treatments, which complement and are alternative
  to medical treatment as defined pursuant to
  section sixty five hundred twenty one of this
  title, to encourage and facilitate the bodys
  self-healing process. The practice of naturopathy
  by a certified naturopathy practitioner involves
  the application of a number of healing systems of
  physical, nutritional or natural agent regimens
• Section 6583. Prohibitions. A naturopathy
  practitioner certified under this article shall
  be prohibited from
• 1.    prescribing or administering drugs as
  defined in this chapter as a treatment, therapy,
  or professional service in the practice of
  naturopathy or
• 2.   using invasive procedures as a treatment,
  therapy, or professional service in the
  practice of naturopathy. For purposes of this
  subdivision, "invasive procedure" means any
  procedure in which human tissue is cut, altered,
  or otherwise infiltrated by mechanical or other
  means. Invasive procedure includes but is not
  limited to surgery, lasers, ionizing radiation,
  therapeutic ultrasound, electroconvulsive
  therapy, electrical shock therapy or
  electromyography or

2.    
8
MSSNY definition cont.

• 3.   practicing or claiming to practice as a
  medical doctor, osteopath, dentist, podiatrist,
  optometrist, psychologist, registered practice
  nurse, advance practice professional nurse,
  midwife, physician assistant, chiropractor,
  physical therapist, acupuncturist, mental health
  therapist or any other health care professional
  not authorized in this chapter or
• 4.   using anesthesia or any other means of
  sedation in the practice of naturopathy or
• 5.   providing obstetrical services or
• 6. providing psychotherapy services.

9
NYACP suggestions/NIH definition

• A first visit to a naturopathic practitioner is
  usually an extended appointment. The practitioner
  will interview the patient at length about his
  health history, reasons for the visit, and
  lifestyle (such as diet, stress, alcohol and
  tobacco use, sleep, and exercise). The
  practitioner may perform examinations and, if in
  her scope of practice, order diagnostic and
  screening tests. Toward the end of the
  appointment, a management plan is set up to
  address the patient's general health and problems
  with illness. Referrals to other health care
  providers may be made, if appropriate.
  Practitioners may deliver some naturopathic
  treatments in their offices, such as hydrotherapy
  or manipulation.
• Examples of additional treatments are
• Dietary changes (for example, eating more whole
  and unprocessed foods)
• Vitamins, minerals, and other dietary supplements
  
• Over the counter Herbal medicine as defined the
  FDA

10
NYACP suggestions cont

• Counseling and education on lifestyle changes
• Homeopathy
• Hydrotherapy (for example, applying hot water,
  then cold water)
• Manual and body-based therapies such as
  manipulation and mobilization
• Exercise therapy
• Mind-body therapies such as yoga and meditationA
  conscious mental process using certain techniques
  such as focusing attention or maintaining a
  specific posture to suspend the stream of
  thoughts and relax the body and mind.
• Furthermore, NYACP feels the definition should be
  COMPLEMENTARY not ALTERNATIVE medicine putting
  emphasis on the fact this is an addition to not a
  substitute for traditional medicine
• NYACP suggested adding ordering labs and ordering
  radiology tests to the prohibitions set forth by
  MSSNY

11
S2426B/A3933BCollaborative Drug Bill
w/Pharmacists

• This bill authorizes a demonstration for
  pharmacists to perform collaborative drug therapy
  management with physicians or nurse
  practitioners in certain settings
• Provisions/Concerns
• NYACP suggests limiting scope of authority to
  Coumadin/Warfarin
• NYACP opposes pharmacists diagnosing, treating
  patients, and prescribing drugs

12
Collaborative Drug Bill cont.

• NYACP would like to see some type of oversight
  measures/ sunset review if the Warfarin trials
  were to go into effect
• STATUS of Bill
• Senate Passed Senate Delivered to Assembly
  Referred to Higher Education (6/24/08)
• Assembly Bill amended recommitted to Higher
  Education (1/10/08)

13
S8673/A2140Pharmacist as Immunizer

• Authorizes pharmacists to administer immunizing
  agents for adults (Influenza, pneumococcal, and
  emergency tx of anaphylaxis)
• Provides that such a pharmacist may execute a
  non-patient specific regimen prescribed or
  ordered by a licensed physician/MD
• Pharmacists must be trained in screening, record
  keeping, handling emergencies, and
  contraindications

14
Pharmacist as Immunizer

• In 2000, ACP and American Society of Internal
  Medicine (ASIM) issued a report supporting
  pharmacists as immunizers as allowed by state
  law.
• After much discussion, the New York Academy of
  Medicine, the NYC Dept of Health and NYACP
  supported passage with additional provision to
  notify
• physicians of immunization and to study
• distribution of vaccine supplies
• MSSNY continued to oppose
• STATUS of Bill
• Passed Senate and Assembly
• Governor Signed into Law

15
S4642/A6723Peer Review

• Prohibits disclosure of testimony of a party to a
  health care quality assurance or peer review
  proceeding
• NYACP drafted and supported a bill in efforts to
  increase physician reporting and participation in
  QA and QI activities
• STATUS of Bill
• Senate Committed to Rules (6/24/08)
• Assembly Amended and recommitted to Codes
  (6/05/08)

16
S8722/A11461HIV Testing Proposal

• DOH Program Bill Relates to HIV testing removes
  provisions requiring separate written consent for
  HIV testing increases the penalty to 10,000 for
  a person who discloses confidential HIV related
  information.
• Incorporate separate written consent into the
  general consent for medical care verbal notice
  will be given when test performed
• Bill will increase testing, protect healthcare
  workers,improve quality of care for HIV pts,
  protect privacy

17
HIV Testing Proposal cont.

• Eliminate pretest counseling and instead tailor
  counseling to whether the result was
  positive/negative
• Allows for testing in occupational exposure where
  pt unable to give consent
• More accurate reporting of actual incidence of
  disease if more tested
• STATUS of Bills
• Senate Recommitted to Rules (6/24/08)
• Assembly Recommitted to Rules (6/23/08)

18
HIV Legislation

• Other proposals
• Assemblywoman Mayerson A4813/S7529 (we like this
  bill) puts HIV testing in line with CDC
  guidelines
• Assemblyman Gottfrieds original version (prior
  to HOD bill)

19
Coverage for Intoxicated DriversA10000/S8294

• Legislation passed both Senate and Assembly and
  is now pending with the Governor. This corrects
  a long standing inequity of no-fault failure to
  pay for medical expenses relating to a DWI
  accident. An amendment was added this year that
  allows the insurer to bill back the patient for
  charges incurred in these instances.
• This legislation has been introduced for more
  than 10 years and was passed by the Legislature
  and vetoed by both Governors Cuomo and Pataki.

20
S8184/A11560Disaster Preparedness

• Lifts licensure restrictions for nurses other
  health practitioners (EMTs) to allow
  immunizations,vaccines, blood testing,etc. in
  declared emergency
• An act to amend public health law, edu law,
  social services law, and county law in relation
  to pandemic flu and public health emergency
  preparedness, detection and response
• Status of Bill
• Senate Referred to Health Committee (5/09/08)
• Assembly Referred to Health Committee (6/12/08)

21
A10942/S8623Immunization of Health Care Workers
Students

• An act to amend public health law, in relation to
  immunization of health care workers (HCW) and
  students and vaccination for STDs
• Pneumococcal vaccination not required for
  employees of long term care facilities
• Require college students to be vaccinated against
  meningococcal disease and 7th graders
  transferring, entering or repeating grade
• Status of Bill
• Senate Referred to Rules (6/19/08)
• Assembly Amended and Recommitted to Health
  (6/20/08)

22
Dept. of Health Proposal 314 (not yet
introduced)Controlled Substance Bill

• Curtail the diversion,abuse, and sale of human
  growth hormone, anabolic steroids, and pregabalin
  as controlled substances
• NYACP ok with bill except for inclusion of
  pregabalin (Lyrica) as a controlled substance
• Lyrica is an anti-seizure med. Also used for
  neuropathic pain and fibromyalgia
• Usage is widening and not narcotic or
  particularly dangerous

23
A11187/S8556Pharmaceutical Gift Ban

• Bans gifts and payments to prescribers by drug
  manufacturers and requires disclosure of gifts
  and payments above 50 aggregate per yr.(includes
  physician and staff)
• Penalties of 2500 for docs who violate and
  10,000 for pharm companies professional
  misconduct
• Presenters of CMEs must disclose financial
  relationships with drug manufacturers, and
  description of any material to be disseminated by
  manufacturer
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

24
Pharmaceutical Gift Ban cont.

• NYACP concerned with the lack of recognition of
  existing ACCME requirements
• Purvi and Linda to convey Health Committee debate
  (5/28/08)
• Status of Bill
• Senate Reported to Rules (6/17/08)
• Assembly Off the floor in Codes (6/23/08)

25
A11136/S8298Patient Safety Bill(OPMC Reform and
Infection Control)

• Strengthen oversight of physicians w/ continuous
  review of medical malpractice claims and payouts
  by Office of Professional Misconduct (OPMC)
• Require courts to report criminal sentences
  against docs
• Making public filing of charges by BPMC
• Allows Access to Physicians personal health
  records without consent and without court
  order!!!!!

26
Patient Safety Bill cont.

• Dept of health can direct a physician to cease
  activities that may harm public health
• Compel physicians to cooperate with
  investigations
• Office based surgery practices must report
  transmission of disease within practice
• Require infection prevention training in med
  school and residency
• Conduct study on viability of restricting the use
  of multi-dose vials and requiring use of
  disposable med. Equipment for single use.

27
Patient Safety Bill cont.

• Status of Bill
• Passed Senate and Assembly
• Signed into Law by the Governor

28
Medical Liability Task Force

• 1.Tort Reform Provisions
• Physician Settlement consent- increase premium
  discount (10 discount) for no consent policies
• Requires naming and supporting Deposing expert
  witness
• Certification of Merit for each defendant
• Expert testimony qualifications court must make
  two prelim findings before admitting expert
  testimony
• Nonbinding early mediation with discovery or
  early settlement conferences mandates parties to
  action participate in non-binding mediation
  before neutral mediators come in. Apologies are
  to be kept confidential and not admissible in
  litigations

29
Medical Liability cont.

• 2.Premium relief/Stability of Medical
  Malpractice Insurance
• Docs in risk mitigation programs receive a
  discount
• Cure MMIP deficit
• Enhance MMIP/MMIA rating/MedMAL
• Reopen MMIA- MMIP deficit would be runoff and no
  new policies would be written
• Lower state excess amounts from 1.3-gt1 million
  and increase state coverage thereby reducing
  physician premiums of 9-12 !

30
Medical Liability cont.

• 2. Premium relief continued
• Reduce primary policy limits further for
  EVAPS,OBs, and who qualify for doctors across New
  York programs
• Lowers premiums on those who serve underserved
  areas

31
Medical Liability cont.

• 3. Patient Safety
• OB/Gyn safety Institute to improve obstetric care
  in NYS (modeled on states experience with
  cardiac care)
• Peer review protections/confidentiality
• Bolster medical-malpractice data-analysis
  capabilitiesdevote resources in DOH, OPMC,
  Patient Safety Center, and DOI
• Update and analyze med. Malpractice database for
  patient safety,risk management, and insurance
  purposes,
• Enhance OPMCs ability to bring disciplinary
  action against negligent providers

32
Medical Liability Continued

• While the Task Force did not release its
  recommendations, the Insurance Commissioner
  announced a temporary hold on premiums as of July
  1st.
• When legislature went into special session on
  August 8 they passed legislation mandating a
  one year freeze at 2007 levels and limited
  ability of the DOI Commissioner to impose any
  surcharge for one year.

33
A9891Anti-Torture Bill

• Prohibits participation in torture and improper
  treatment of prisoners by health care
  professionals
• Sent bill to ACP ethics committee for comments.
  To be reviewed 6/3/08.
• STATUS of Bill
• Reported and referred to rules (6/17/08)
• Meeting scheduled with Assemblyman Gottfried on
  Friday, October 10th