Attorney General Announces Parity Settlements with ValueOptions and Excellus Health Plan
The New York State Attorney General's Office recently announced two new settlements with insurance carriers aimed enforcing federal and state parity laws. On March 5, 2015, the Attorney General's Office released details regarding its settlement with ValueOptions (now known as Beacon Health Options), the managed care company that administers behavioral health benefits for The Empire Plan, MVP Health Care and EmblemHealth, among others. Just two weeks later, on March 18th, the Attorney General announced a settlement with upstate carrier Excellus Health Plan, part of the Blue Cross Blue Shield Association.
The Deadline for Mandatory Electronic Prescribing in New York has been Postponed until March 27, 2016
Visit the E-Prescribing section of our website where you will find a copy of the live webinar, FAQs about electronic prescribing and resource links. Additional information will be added as it becomes available.
Open Payments Physician Data Will Be Posted September 30, 2014 Initial Deadline of August 27, 2014 to Review and Dispute Inaccuracies
Under the Open Payments program, CMS is required to publish data annually regarding payments and other transfers of value received by physicians from healthcare manufacturers and group purchasing organizations. Physicians may register to view any financial data reported about them and request corrections where necessary.
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.
Dr. Kroplick Named NYSOM's Physician of the Year
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
ACA Audit Requests
Some NYSPA members have recently received requests for patient records sent by or on behalf of insurance carriers. These requests cite audit requirements established by the Affordable Care Act.
Federal law prohibits your private health insurance plan from discriminating against you because you have a mental illness, including a substance use disorder. Click here to download a copy of a poster prepared by the APA that outlines your rights.
United Health Care Class Action Suit Update
On Tuesday, April 22nd, attorneys representing NYSPA and other plaintiffs in our federal lawsuit against United Health Care, filed our brief with the US Court of Appeals seeking to overturn the lower court decision dismissing our case.
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 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
NYSPA Launches Veterans Mental Health – Primary Care Training Initiative
The New York State Psychiatric Association was pleased to present the inaugural training session of the Veterans Mental Health – Primary Care Training Initiative (VMH-PCTI), a comprehensive program addressing veterans' mental health issues, at the Albany Medical Center, in Albany, New York, on Friday, November 14, 2014. The program was jointly hosted by the Capital District Branch of the American Psychiatric Association and the Albany Medical Center Department of Psychiatry.
NYSPA Signs Joint Letter Urging Delay In Mandatory eRx Implementation
NYSPA has joined with the Medical Society of the State of New York and 17 other provider organizations to urge New York State to delay implementation of the March 27, 2015 requirement for mandatory electronic prescribing because of concerns regarding vendor readiness.
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.
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.
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.