in 2012 and
NY Chapter 1
District II Member,
on the current state of our health care system, it is clear that our
system is in flux. We are challenged daily at the federal,
state and local levels. No matter where or how you practice
pediatrics, these are times of change and challenge
read on for details.
Danielle Laraque, MD, FAAP
Chair, AAP District II, New York State
Our Changing Health Care System
the federal level, the federal government and its agencies, e.g.
CMS, continue to work with states to implement the ACA
(Affordable Care Act), federal health care reform. At the same
time the Supreme Court works on its decision to determine the
constitutionality of the ACA. What happens if the Supreme
Court strikes down the whole law, or parts of the law? How
will it impact what we do in our offices, clinics or academic
work? There are no real answers. So, as we and our state
leaders continue to plan to put all the pieces required by ACA
in place, such as the Health Care Exchange, which was just
created by Executive Order, and expansions in coverage, we are
uncertain about how and how many of the options proposed by ACA
will move forward.
the state level, the state is struggling with its own Medicaid
and Health Care Reform Agenda. The recently passed state
budget includes some good news for children and families.
Lactation counseling and support will now be a covered benefit
for Medicaid. It is our hope that this coverage will soon
migrate to commercial insurance. Also, the budget included
additional investments in the Nurse-Family Partnership program
which provides multiple health and socio-economic and parenting
supports to at risk families with newborns. This evidence
based program has made significant positive impacts on the
thousands of families it has served.
state budget also provided support to current children's health
programs in Medicaid, Child Health Plus and School Based Health
Care. The budget also included support for the state to approve
seven ACO's (Accountable Care Organizations).
budget supported several key issues that we advocated for,
including reforms to strengthen the Early Intervention Program,
supporting New York City's Close to Home Initiative to bring
most non-violent juveniles currently housed in non-secure
upstate state facilities back to New York City for supervision,
treatment and support. Child care services did not
experience cuts to services. And education, always a
contentious area, appears to have been funded at promised, if
not adequate levels.
care reform efforts, centered in the work of the State's
Medicaid Reform Team, the MRT, continue toward implementation.
The state is in the process of implementing benefit coverage
changes to reflect the most recent evidence based science.
There are also major decisions being made to identify and
support county based coalitions to provide Behavioral Health
Home Services. Work is also accelerating on Health Homes
for medically fragile adults and children. The MRT
recommendations can and will have an impact on children's health
services. Exactly how these new initiatives play out is
still to be determined. But we are involved in many
discussions, working to keep the needs of children present in
the ongoing planning. It is imperative that you, in your
communities also remain aware of what is happening around you.
Are you being asked to participate in new partnerships?
Have you been approached about participating in new networks or
coalitions? Are children's needs being considered as the
health services in your communities begin to prepare for the
"reforms" at the federal and state levels? In
that regard, one of the most important potential sources of
community support created by ACA may the community benefit
obligations of nonprofit hospitals that seek federal tax exempt
status. This requirement calls for community health
assessments to engage hospitals in focusing on the specific
health needs of child and adult populations.
working under the pressure of all of these megatrends and
impacts, we are all also continuing to struggle to provide
high quality care to children and families in very difficult
times. Your Pediatric Councils continue to engage
health insurance companies around issues that remain
problematic to pediatricians. Pediatric Councils are
working on securing fair payments for immunization,
challenging unfair bundling of services, working to secure
clear rates in contracting, and encouraging payment for
children's mental health services in primary care setting.
At the same time Pediatric Councils are working with
specific carriers to resolve specific problems experienced
If you are
having specific problems or have been frustrated in trying
to solve a particular problem in your practice, we invite
you to contact the District. We may be able to help
with information, contacts or connection to your Pediatric
cost curve while maintaining access and quality, which is
the goal of all reforms, requires a strong base of primary
care providers. Pediatrics must continue to be a key player
in primary care and care management as we move forward in
this new and changing world.
goal, working with all of you is to keep children's health
and well being central to the ongoing reform planning and
To help the
District continue to be most effective for its members both
internally and externally, we have begun a process of
strategic planning. Working with a key group of District
members we will be meeting in early June to take some first
steps to identify key goals and objectives of our planning
help inform our work, we are encouraging member
participation through focus group conference calls for each
Chapter. If you received an e-mail inviting you to
participate, please make every effort to be on the call and
offer your input. If you cannot be on the call for
your Chapter we hope that you will take a minute to respond
to the areas of question with a short e-mail to your Chapter
Ex. Dir. We really want to include as much member
input as possible as we move forward into the process.
help support our policy and program work, we engage in
targeted Legislative Advocacy.
This year we
have four key legislative initiatives. Two are currently
active bills that require your support. We ask that
you contact your legislators in the Assembly and the Senate
and ask for their support for both bills.
Negotiation legislation which will help level
the playing field between pediatricians and insurance
*Tdap which requires all birthing hospitals
to offer *Tdap immunization to parents and caregivers of
newborns in the hospital setting.
*("Tdap" was incorrectly written as "TDaP"
in the circulated version of this newsletter. "Tdap"
We are on
record in support of raising the age of juveniles tried in
adult court to 18. Recent brain development research clearly
indicates that the adolescent brain is not able to function
at an adult level in terms of its executive function and
decision/consequence matrix. Recognizing this
difference requires a different approach to adolescents who
become involved in the criminal justice system.
Currently New York is only one of two states still trying 16
year olds in adult court. We need to make a change to
reflect the science that is very clear on this issue and we
need to do it this year.
And we are
on record as supporting the requirement that the state
engage in a study of the potential health impacts on
children before making a decision permitting hydrofracking.
You can get
more information on these bills and the District's position
on other legislation and policy issues at www.aapdistrictii.org and
clicking on the Advocacy tab.
District remains engaged at the federal and state levels on
behalf of children and pediatricians. Our strength is
your passion and your voice. Once again we call upon
you all to help us and our state leaders make New York an
ever better place to be a child.