NYSPA Honors C. Deborah Cross, M.D. with Distinguished Service Award
At its Spring meeting on March 22, 2014, the NYSPA Council awarded the NYSPA Distinguished Service Award to C. Deborah Cross, M.D. in recognition of her dedication, prodigious effort, intelligence and leadership in the profession of Psychiatric Medicine nationally and in the State of New York. Dr. Cross has been an active and enthusiastic member of NYSPA for many years, serving two terms as NYSPA President and currently serving as Chair of the NYSPA Public Affairs Committee and Chair of the NYSPA Nominating Committee. Dr. Cross is currently an AAOL Representative to the Assembly and is a past recipient of the Ronald A. Shellow Award. Since 2002, Dr. Cross has been a member of the NYS Board of Professional Medical Conduct Advisory Committee. NYSPA congratulates her on this special recognition.
New CMS 1500 Form Required Beginning April 1st
Beginning April 1, 2014, providers are required to use version 02/12 of the CMS 1500 claim form when submitting paper claims to Medicare.
Click here for additional information from National Government Services regarding the changes and for CMS-1500 claim form completion instructions.
2014-15 Executive Budget Update
April 2, 2014 By Richard Gallo and Jamie Papapetros
The Senate and Assembly passed the budget bills comprising the $138 billion budget Monday and the Governor has signed them into law. NYSPA is proud to report that it achieved many favorable outcomes, including the defeat of efforts to eliminate prescriber prevails in Medicaid, prior authorization requirements for off-label prescribing in Medicaid, as well as a proposal to allow for the establishment of retail clinics (without a statutory exclusion for providing mental health services), while also securing an additional $450,000 in funding for the Veterans’ Mental Health Primary Care Training Initiative, conducted by NYSPA, MSSNY and the National Association of Social Workers – NYS, and major out-of-network insurance reforms.
Attorney General Settles Mental Health Parity Case
Attorney General Eric Schneiderman has settled a case with a major health insurer, MVP Health Care which he said had been denying an inordinate amount of mental health claims. To read a copy of the article click here.
SGR Fix for 2014 Medicare Part B Fees
On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physician services covered under Medicare Part B. The new law also provides a 0.5 percent update for all Medicare Part B fees through March 31, 2014.
New Medicaid Dose Optimization Initiative to Take Effect November 14, 2013
The Medicaid Fee-for-Service program recently established a new Dose Optimization program, which will seek to reduce prescription costs by limiting the amount of pills a patient needs to take each day, while retaining daily dosing amounts. This initiative is expected to result in significant cost-savings for the Medicaid program, since, in many cases, pharmacies charge per pill dispensed.
Court Finds Plausible Parity Violations by United but Requires Claims To Be Brought Against Plan Sponsors
On October 31, 2013, United States District Judge Colleen McMahon dismissed a class action mental health parity lawsuit brought by four patients, a psychologist, a psychiatrist, and NYSPA (on behalf of its members and their patients) against UnitedHealth Group
NYSPA Meets with Ann Sullivan, M.D., Acting Commissioner, NYS Office of Mental Health
On March 7, 2014, NYSPA members met with Ann Sullivan, M.D., Acting Commissioner of the NYS Office of Mental Health to discuss issues relevant to the practice of psychiatry. NYSPA is very pleased with the appointment of Dr. Sullivan, who is the first psychiatrist to head OMH in more than 30 years. The meeting was attended by Glenn Martin, M.D., Seeth Vivek, M.D., Jeffrey Borenstein, M.D., Barry Perlman, M.D., Jim Nininger, M.D., and Edmond Amyot, M.D.
NYSPA congratulates Lois Kroplick, D.O. on being named 2014 Physician of the Year Award by the New York State Osteopathic Medical Society. The award was presented on February 21st at the President’s Reception during the 2014 Regional Osteopathic Convention.
Dr. Kroplick is the first psychiatrist to have received this honor. Click here to view a copy of Dr. Kroplick's acceptance speech.
HHS Issues HIPAA Guidance Document on Sharing Information Related to Mental Health
The U.S. Department of Health and Human Services (HHS) recently released a new guidance document detailing how the HIPAA Privacy Rule operates to protect individual privacy rights with respect to mental health information. The guidance document clarifies when HIPAA permits health care providers to communicate with a patient's family members, friends, or others involved in the patient's care, depending on whether the patient is an adult or a minor and consider the patient's capacity to agree or object to the sharing of their information. In addition, the guidance further clarifies how providers may communicate with family members, law enforcement, or others when the patient presents a serious and imminent threat of harm to self or others.
The guidance document may be downloaded by clicking here
Governor's Office Announces Delayed Implementation of Regional Centers of Excellence Plan
On December 19, 2013, Governor Cuomo announced a delay in implementation of the Regional Centers of Excellence (RCE) Plan, an initiative to shrink the state inpatient mental health care system.
December 17th Medicare/CPT Coding Update Click here to register. No charge for Members. Non-member fee is $250.
NYSPA/APA Successful in Reversing Improper Denials of Claims Submitted To UBH/Optum
NYSPA was recently contacted by two members who had been receiving improper denials from United Behavioral Health/Optum for claims for the new combination psychotherapy CPT codes (e.g., 99212+90836), Optum was refusing to provide reimbursement for the psychotherapy add-on code because the provider had failed to document start and stop times for the psychotherapy portion of the session alone (as opposed to the E/M portion). This practice, clearly in violation of CPT, was being applied to both in-network and out-of-network benefits.
The eRx Incentive Program Ended in 2013, but Electronic Prescribing Continues with Meaningful Use
2013 was the final program year for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program. The 6-month 2014 eRx payment adjustment reporting period, which began on January 1, 2013 and ended on June 30, 2013, was the final reporting period to avoid the 2014 eRx payment adjustment. You do not need to report G-codes (G8553) for 2014 eRx events.
• 2013 was the last year to earn an eRx incentive payment • 2014 is the last year to incur an eRx payment adjustment
NYSPA Asks Governor to Intervene To Correct Parity Violation
NYSPA recently contacted Governor Cuomo to ask for his assistance in eliminating Value Options' recently re-instituted prior authorization requirement for psychotherapy benefits under the Empire Plan, the health plan for state employees and their families. As the new behavioral health administrator for the Empire Plan, Value Options announced, effective January 1, 2014, a new prior authorization requirement to be imposed on all psychotherapy services that exceed a 10-visit limit. As described in more detail in our letter to Governor Cuomo, NYSPA strongly opposes the prior authorization requirement because it represents a clear violation of federal parity law and regulations. A copy of NYSPA's letter to Governor Cuomo may be viewed here.
Psychologists To Pursue Prescribing Authority in New York
We are taking this opportunity to communicate directly to our members about an issue of critical importance. Organized psychology has indicated its intent to pursue prescribing authority for psychologists in New York State in the coming legislative session
On November 29, 2013, CMS issued its interim final rule establishing Medicare RVU values for 2014. CMS accepted all the increased values recommended by the RUC for the new psychiatry psychotherapy codes to be used only in combination with an E/M code.
Obama Administration Issues Final Rule Implementing Mental Health Parity and Addiction Equity Act
On Friday, November 8, 2013, the Obama Administration issued a Final Rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). In general, NYSPA and the APA are pleased with the Final Rule, which includes clarification on many important issues, including insurer transparency, nonquantitative treatment limitations and reimbursement rates, among others.
To read the APA Talking Points on the Final Rule, please click here. To read the APA Talking Points on the Parity Law in general, please click here.
DOH Establishes Transition Period for I-Stop Compliance
As you know, the new I-Stop duty to consult goes into effect on August 27, 2013. The Department of Health recently posted the below message on its website, which indicates that all practitioners unable to establish an HCS account and access the PMP despite good faith efforts may continue to write prescriptions for Schedule II, III and IV medications. DOH expects this period of transition to last through October 2013.