Almost all pediatricians who see Medicaid patients will be eligible for the increased payments retroactive to January 1, 2013.
The information that you received from the National AAP is not relevant to New York State at this time.
Access the above form as soon as possible.
Vaccine Safety…If Your Office Lost Power During Sandy (November 2012)
How Best to Secure Your Vaccine Supply & Ordering Replacement Vaccines (VFC and Commercial)
Details and specific instructions from the NYSDOH and the NYC DOHMH are available in these two formal communications:
Children’s Emotional Responses to Sandy
Many children lost their homes, parts of their neighborhoods and are attending different schools. They are dealing with high levels of stress from parents and other family members. Many are in shelters, or have been stuck in their own apartments or houses without heat or electricity for more than a week. Even children not directly in the path of the storm have been exposed to frightening media reports. You may see the results of these emotional stressors in the children you care for.
Here are some resources available to help you help your child patients respond to fears and anxieties brought on by Superstorm Sandy:
- http://nysaap.org/child-and-adolescent-psychiatry-for-primary-care/ - CAP PC (Child and Adolescent Psychiatry for Primary Care)
- http://www2.aap.org/disasters/toolkit.cfm – “Feelings Need Check Ups Too”
Medicaid/Medicare Payment Rule
CMS, the federal agency working on Medicaid and Medicare, has issued its final rule on the the Medicaid/Medicare Payment Rule. NYS is now actively planning for the design and implementation of the increased payments to pediatricians.
Your AAP District II (NYS) representatives are meeting with State Department of Health senior staff to provide input into the state’s planning. Our goal is to help design a simple, transparent process to get dollars from the federal government into the hands of primary care pediatricians.
For more information, please see the following documents:
- CMS Finalizes ACA Medicaid Payment Increase Rule (written by the National AAP)
- Medicaid Primary Care Rate Increase Final Rule: Fast Facts (written by the Center for Health Care Strategies, Inc.)
On January 1, 2013, New York State’s Medicaid program will no longer offer incentive payments to practices that have attained NCQA Level One. The State will continue payments to practices that are working toward or that attain Levels Two and Three.
The State defines its expectations in this letter to all physicians:
With the election over, NYS is moving full steam ahead with the implementation of its Health Insurance Exchange. The State has demonstrated the proposed internet universal portal to the State Exchange Advisory. It is apparent that New Yorkers will be purchasing insurance by internet within the next 12 months. It is imperative that you talk with your families about how to maintain their relationship with you as they are faced with various options to purchase insurance for themselves and their children.
Adolescent Sexual Health Webinar Series (October 2012)
AAP District II (NYS), in partnership with PRCH, and the NYC PTC has offered a series of Webinars on topics related to Adolescent Sexual Health Services
in Pediatric Primary Care. All webinars are now available online.
The Concussion Act of NYS (July 2012)
The Concussion Act of NYS took effect July 1, 2012, and requires schools to:
- Educate parents, athletes, coaches, athletic trainers, physical education teachers, and school nurses on concussion,
- Remove observed or suspected concussed students from play based on signs and symptoms,
- Withhold further participation until evaluated by, and received written and signed authorization to return to activities from a licensed physician.
- Obtain physician clearance, and when the athlete has been symptom-free off pain killing medicines for a minimum of 24 hours and allow them to begin a monitored progressive six phase return to play.
Current thinking is that optimal recovery of concussed students occurs when there is cognitive, physical, and emotional rest following injury. Additionally, research has shown that 92% of second injuries occur in the first week following the initial injury, and the goal is to allow adequate recovery time before allowing a student to risk re-injury. Pressure to return an athlete before it is safe can be intense from parents and athletes. Primary care physicians are being asked to assist in the process of keeping injured children safe by remaining objective and withholding participation until it is deemed safe with a reasonable degree of medical certainty.
MAKING A CLINICAL DETERMINATION
- Symptoms: somatic (e.g. headache, nausea, dizziness), cognitive (e.g. feeling in a fog), and/or emotional (e.g. lability)
- Physical signs: history of loss of consciousness, amnesia, poor coordination or imbalance, vomiting, sensitivity to bright light & loud noise
- Behavioral changes: irritability, personality changes
- Cognitive impairment: Hard time concentrating, trouble remembering, not feeling themselves, being confused, thinking speed slowed down, taking a longer time to react
- Sleep disturbance: drowsiness, insomnia
WHAT PHYSICIANS NEED TO KNOW ABOUT HOW SCHOOLS WILL MANAGE CONCUSSION
When unfunded state mandates are imposed directly on schools and indirectly on community physicians, communications among all parties is essential to enhance optimal outcomes for your patients. Therefore, it is important to determine how your local districts are planning to comply with the law. The full Informational Detail is available on the AAP District II website.
GRADUATED RETURN TO PHYSICAL EXERTION AND ACTIVITY OR RETURN TO PLAY (RTP)
This is a six step gradual return to activity. The RTP protocol may not start until an athlete is completely symptom-free for a full 24 hours off pain killing medicines, and must remain symptom-free for 24 hours following each stage before progressing further.
Average recovery following concussion is about a week to ten days; protracted recovery with post concussion syndrome is after 21 days. Young teenage girls often have protracted recovery more than any other group.
RETURN TO LEARN (RTL)
More information will be forthcoming about RTL (cognitive return to school), but we anticipate a similar slow exertional challenge as we see in RTP. The graduated steps begin after the student has a medical clearance to return to academics, and is symptom free off pain killing medicines for a full 24 hours. RTL should be an individualized steady progression with the parent’s checking the child daily for a return of symptoms and alerting you if the student is struggling so you can provide appropriate requests for medical accommodations to the school as needed. Unlike a RTP, the RTL might start at any level and progress at a rate individualized to the student’s needs and tolerance. Steps might be skipped as tolerated and might look something like this:
Students with reasonable recovery times typically will get accommodations within the school by the principal. Students with protracted recovery beyond about 10 weeks, a school quarter, are likely eligible for a 504 plan or an IEP, and you might be asked to write a request to support the family at that time.
More information and detail on each section is available on the AAP District II website.
Also you can get more information from Cindy Devore, MD, FAAP at firstname.lastname@example.org
Exciting Opportunity to Participate in AAP/CDC Vaccine Bar Coding Pilot (January 2012)
New York State pediatricians, along with their colleagues in eight other states, are invited to participate in an AAP/CDC national pilot on Vaccine 2D Bar Coding and data transfer. All practices are welcome, from solo practitioners to the largest institutional networks.
Each participating practice will receive a scanner to keep, financial support, and an identified Technical Trainer and Support Person to work with them through the duration of the pilot. Participation will place your practice on the cutting edge of vaccine management and tracking. It will also allow you to move data automatically to both registries, billing and electronic health records.
To participate/for more information:
AAP NY Chapters 2 & 3 members should contact:
Elie Ward, Executive Director, Chapters 2 & 3, at email@example.com
AAP NY Chapter 1 members should contact:
Nancy Adams, Executive Director, Chapter 1, at firstname.lastname@example.org
This is an exciting opportunity for New York State practices to enter the next phase of vaccine information and billing procedures with the help and support of a national project team. We look forward to hearing from you and hope you will decide to take advantage of this great opportunity!
Having Problems Getting Medicaid Managed Care Prescriptions Filled? (December 5, 2011)
Read on to get help from the NYSDOH!
Each Medicaid Managed Care plan has been assigned a New York State Department of Health (DOH) pharmacist for the purpose of working collaboratively to resolve issues. DOH staff will address both general issues and member/provider specific issues with the specific Medicaid Managed Care plan.
Please contact the DOH with questions, concerns, or if you are experiencing difficulty with a plan:
The New York State Department of Health staff will assist you in contacting the plan and working towards resolutions of your issues.
Additionally, detailed information regarding the MRT pharmacy initiatives can be found on the DOH website. This includes:
- Frequently Asked Questions (FAQs),
- a timeline of communication activities,
- transition plan information,
- a single point of entry for access to managed care plan,
- pharmacy benefit manager
- and formulary information
Please visit the DOH website to find out more at: MRT Proposals
To download a helpful document outlining recent changes, Click Here
If you continue to have problems, contact Elie Ward, the AAP District II Director of Policy and Advocacy, at email@example.com