May 2011

In This Report
Physicians' Rights to Negotiate with Insurers
NYS Budget & Children's Health
NYS Medicaid Redesign Team
Additional AAP District II Initiatives
 
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Adolescent Webinar
June 1, 2011
1:00pm - 2:30pm

 

Dear AAP District II Member,  

These are interesting times for medicine and for pediatrics. The National AAP keeps us informed about what is happening in Washington, describing the work of the Congress and the Administration on health care reform implementation.  

 

Here in New York, we have our own issues as:

  • the Cuomo Administration continues its Medicaid Redesign Team (MRT) efforts
  • the NYSDOH and State Dept. of Insurance begins to design the state's Health Insurance Exchange and to implement the electronic health record "meaningful use" called for in the Health Care Reform legislation
  • the state Senate and Assembly passed legislation that will create seven ACO (Accountable Care Organization) demonstrations starting this year, and as
  • work is accelerating on implementing Medical Homes and encouraging practices to work toward NCQA certification.

Please read on to learn more about health care in NYS and what your District is working on to help pediatricians and their patients.

 

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State
 
Physicians' Rights to Negotiate with Insurers
 

There is legislation in both houses of the State legislature to support physicians' rights to negotiate with insurers.  Should this pass, it would help level the playing field as groups of pediatricians in a region could negotiate as a group with the insurers in that region. The group negotiation approach has a better chance to assure adequate and prompt payment as part of the contracting process than the current process of each pediatrician contracting alone.  The proposed legislation would eliminate the "restraint of trade" preclusion that weakens the current pediatrician/insurer relationship.

 

We encourage you to contact your state Assemblyperson and your Senator and ask them to bring the bill to the floor for a vote and of course, to support the bill.

 

Click here to view the District's Memo of Support.

 

 
NYS Budget & Children's Health
  

Victories

 

This is also the first year in a very long time that the state has an on time budget.  And the new budget did not decimate children's health:

  • SCHIP and Medicaid were maintained with adequate support
  • There were no cuts to basic primary care
  • Support for pediatric training in children's mental health was also maintained *

* We are currently registering our second class of pediatricians for free intensive training and consultation support to bring children's mental health services into the pediatric primary care setting. You can register and get more information here

 

Although there were significant cuts to education, and some reductions in child care and consolidations in child welfare services, New York's pediatricians and their child and family patients did ok, especially considering the enormity of the state budget deficit and the kinds of decisions that are being made in other states with deep deficits.

 

Challenges

 

However, there are still significant challenges in our children's health system.  We continue to work on:

  • Trying to get all pediatricians adequate payment for vaccine administration.  The disparity in payments between insurers and across regions is simply wrong and inequitable.  
  • Assuring that all pediatricians have access to children's immunization records from both the New York State Immunization Registry (NYSIIS) and the New York City Registry (CIR).
  • Creating systems that require the state to require insurers to pay for services that are added to basic services.  One example is autism assessments and developmental screening to meet recent state requirements.  Another is the newly developing processes and procedures for Newborn Hearing Screening and Follow-up.
 
 
NYS Medicaid Redesign Team
 

The State's Medicaid Redesign Team process has completed Phase One in presenting a budget and legislation to implement budget changes and programmatic reforms, and is moving to Phase Two, which will see the development of Subcommittees to work on recommendations for reform moving forward.  We are working hard to assure that children's health concerns are a part of the discussion.  We are hopeful that there will be pediatric representation on several of the key subcommittees, i.e. Payment Reform, Basic Benefit Package Design, Behavioral Health Reform, and Program Streamlining.  New York really cannot talk about Medicaid without talking about children. Our patients are more than half of the Medicaid consumers, although we only use about 19% of the program's resources.

 

 
 
Additional AAP District II Initiatives
 

Your District's committees are working on several fronts on behalf of pediatricians and the children we serve: 

  • Immunization Issues: Nuts & Bolts Committee: focusing on the challenges in practice
  • Immunization Issues: Communication Committee: focusing on public perceptions of vaccine safety, pediatrician skills in vaccine advocacy and family decision making about vaccines
  • Committee on Children's Mental Health
    works with the Office of Mental Health and the Academic Medical Centers with Child Psychiatry Departments to bring intensive training and case support to pediatricians across the state
  • Committee on Early Childhood Development
    focusing on the key pediatric/developmental issues in the first five years of life.

The District is also working with a small grant from the National AAP on providing training to pediatricians on implementation of the new EPT (Expedited Partner Therapy) regulations.  Click here for more information. 

 

And we have ongoing meetings with all insurers through the work of our Chapter based Pediatric Councils.  These groups bring pediatric specific issues to the table to discuss with the insurers in your area.  The District is working for and with you on multiple issues and with multiple public and private partners to assure optimal pediatric care across the state.

 

We encourage you to become more active in the District, through legislative and policy advocacy, joining one of our committees, joining a training opportunity to enhance your practice skills and/or by becoming more active in the local work of your AAP NY Chapter.

 

District II (New York State), American Academy of Pediatrics
408 Kenwood Avenue, 2nd Floor | Delmar, NY 12054
518/439-0892 | Fax:  518/439-0769 | www.aapdistrictii.org