For NYSPA, we fared well while continuing to face some perennial scope of practice and corporate practice issues as well as a new one -- legislation permitting psychologists to prescribe medications. NYSPA is proud to report that it prevailed on all of these issues and extends its appreciation to members who have advocated, through emails, letters or phone calls, to their legislators. It made a difference. Many thanks for all of your efforts. Below is a preliminary summary on the status of the major issues of concern or interest.

Senate Confirms Governor’s Nominee to Be Commissioner of OMH: Ann Marie Sullivan, M.D.

Early Friday morning, the Senate confirmed Ann Marie Sullivan, M.D., former NYSPA representative to the APA Board of Trustees and Recorder and Speaker of the APA Assembly, as the Commissioner of the Office of Mental Health (OMH). Dr. Sullivan has been the Acting Commissioner of OMH since November.

Senate Confirms Dr. Martin As Member of Public Health and Health Planning Council

The Senate confirmed the Governor’s reappointment of Glenn Martin, M.D., immediate past president of NYSPA, to be a member of the Department of Health’s Public Health and Health Planning Council (PHHPC). Dr. Martin will serve a five year term. PHHPC is the body that among its duties considers Certificate of Need applications for the establishment, ownership and construction of health care facilities in New York State. 

Update on Scope of Practice Bills

The myriad of scope of practice bills, pertaining to psychologists, podiatrists, dentists, optometrists and many more, which NYSPA has opposed along with MSSNY, and the other medical specialties, remained in committee. Of concern for NYSPA, here is a quick rundown:

• S.7488 (Young) – Bill authorizes psychologists to prescribe, administer, or discontinue drugs or controlled substances recognized in or customarily used in the diagnosis, treatment, and management of individuals with psychiatric, mental cognitive, nervous, emotional or behavioral disorders. There was no Assembly companion bill introduced before the end of the legislative session. (NYSPA Opposed)
• A.4886-A (Ortiz)/S.3280-A (Carlucci) – Bill expands the scope of practice, duties and responsibilities of psychiatric nurse practitioners to be equivalent to a physician/psychiatrist with respect to voluntary and informal  psychiatric hospital admissions pursuant to Sections 9.13  and 9.15 of Article 9 of the Mental Hygiene Law. (NYSPA Opposed)
• A.6563 (Ortiz) – Bill amends the Criminal Procedure Law regarding the determination of a defendant's mental fitness to understand the proceedings against him or her or to assist in his or her own defense in a criminal proceeding by adding the professions of licensed clinical social workers and licensed nurse practitioners in psychiatry to the definition of “psychiatric examiner,” the professionals who may conduct such examinations. (NYSPA Opposed) 
• A.7608 (DenDekker)/S.4977 (Robach) – Bill amends the scope of practice of mental health practitioners, including mental health counselors, marriage and family therapists, psychoanalysts and creative arts therapists, to include diagnosis. (NYSPA Opposed) 
• A.7860 (Perry)/S.4828-A (LaValle) – Bill regulates the practice of naturopathy and provides for licensure. (NYSPA Opposed)

 Update on Priority Bills/Bills of Interest

• A.6983-B (Glick)/S.4917-B (Hoylman) – Prohibiting Conversion Therapy for Minors – The Assembly passed A.6983-B by a vote of 105 to 28, whichwould prohibit mental health professionals, defined as physicians, social workers, psychologists and the four mental health practitioners, from engaging in efforts to change an individual’s sexual orientation who is under the age of eighteen. The Senate bill (S.4917-B) remained in the Senate Higher Education Committee. (NYSPA Supported)
• A.9768-A (Gunther)/S.7481-A (Hannon) – Surveys for Dually Licensed Hospitals – This legislation would amend the Mental Hygiene Law to permit the Office of Mental Health (OMH) and Office of Alcoholism and Substance Abuse Services (OASAS) to accept surveys from national hospital accrediting organizations for outpatient mental health and substance abuse services for hospitals dually licensed under the Public Health Law and Mental Hygiene Law.  Currently, general hospitals that are dually licensed are required to comply with separate and duplicative surveys from OMH and OASAS for outpatient mental health and substance abuse services.
• A.9768-A passed the Assembly and Senate unanimously.  (NYSPA Supported)
• A.801 (Weprin)/S.3481 (Ranzenhofer) – Psychology LLC Bill – The Assembly Higher Education Committee held A.801 in committee for further consideration, which would authorize psychologists and non-psychiatrist physicians to form limited liability companies, professional corporations and partnerships with one another. The Senate bill remained in the Senate Corporations, Authorities and Commissions Committee. (NYSPA Opposed) 
• A.3910 (Pretlow) – Mental Health Practitioners & Social Worker LLC Bill – Bill authorizing licensed clinical social workers, licensed creative arts therapists, licensed marriage and family therapists, licensed mental health counselors and licensed psychoanalysts to form a single corporate structure remained in the Assembly Higher Education Committee. (NYSPA Opposed) 
• A.5124-B (Paulin); S.4069 (Hannon) Retail Clinics (i.e. Limited Services Clinics) – Bill to authorize the establishment of for-profit limited services clinics (i.e. retail clinics) advanced to the Senate calendar but was not taken up for a vote and remained in committee in the Assembly. (NYSPA Opposed) 

Package of Bills on Heroin & Opioid Abuse
The Governor and Legislature announced an agreement on a package of eleven bills focused on ensuring access to treatment, raising public awareness and strengthening penalties for illegal drug distribution to combat the heroin and opioid abuse epidemic. Of concern for physicians, the agreement did not include proposals to:

(1)    Require physicians and other health care professionals to complete three hours of continuing medical education (CME) every two years on pain management, palliative care and addiction.

(2)    Limit the initial prescription or dispensing of a controlled substance for acute pain to a three to ten day supply.

Here is a list of the bills the Legislature passed with a message of necessity from the Governor and a brief summary: 

Also of note, legislation (S.6477-B) passed both Houses earlier in the Legislative Session pertaining to the Department of Health’s Opioid Overdose Prevention Program. The legislation authorizes a health care professional, who has the authority to prescribe under Title VIII of the State Education Law, to prescribe, dispense or distribute an opioid antagonist, defined as Naloxone and other medications approved by the Department of Health, through a patient-specific or non-patient specific prescription. Pharmacists would be permitted to dispense Naloxone through a patient-specific or non-patient specific prescription. The purpose of this is to provide greater access to Naloxone to an opioid antagonist recipient, defined as a “person at risk of experiencing an opioid-related overdose, or a family member, friend or other person in a position to assist a person experiencing or at risk of experiencing an opioid-related overdose, or an organization registered as an opioid overdose prevention program …” The legislation was delivered to the Governor on Monday, June 23, 2014. (NYSPA Supported)

Medical Marijuana
One of the late breaking agreements reached was legislation authorizing the medical use of marijuana. NYSPA did not take a position on the bill. Here are some of the specifics of the bill (A.6357-E, Gottfried), which passed the Assembly by a vote of 117-13 and the Senate by a vote 49-10:  

• Under the program, patients with serious medical conditions can be certified by a physician to use medical marijuana. Smoking of medical marijuana is prohibited.
• The serious medical conditions include cancer, HIV/AIDS, amyotrophic lateral sclerosis, Parkinson’s Disease, multiple sclerosis, damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity, epilepsy, inflammatory bowel disease, neuropathies, Huntington’s disease  or those added by the Commissioner of Health. The Commissioner of Health has 18 months (from the date the bill is signed into law) to decide if the following conditions should also be permitted: Alzheimer’s, muscular dystrophy, dystonia, post-traumatic stress disorder and rheumatoid arthritis.
• Only physicians licensed in New York State who meet the following conditions would be authorized: (1) by training or experience is qualified to treat a serious condition, (2) has competed a two to four hour course as determined by the Commissioner of Health through regulation, and, (3) registered with the Department of Health.
• There would be five registered organizations, who must go through an application process, and twenty dispensaries.
• There is no requirement for an insurer or health plan to provide coverage for medical marihuana.
• The Department of Health has 18 months from the date the bill is signed to prepare for the program’s implantation.
• The Governor maintains the authority to terminate the program upon the recommendation from the Commissioner of Health and/or the Superintendent of State Police that there is a risk to public health or safety.
• There will be a 7 percent excise tax to be allocated as follows: 22.5% to the county in New York State in which the medical marijuana was manufactured; 22.5% to the county in New York State in which the medical marijuana was dispensed; 5% to the State Office of Alcoholism and Substance Abuse Services to be used for additional drug abuse prevention, counseling and treatment services; and 5% to the Division of Criminal Justice Services to support law enforcement measures related to this legislation.
• The legislation sunsets in seven years.

Medical Malpractice Bills
NYSPA and a number of specialties joined MSSNY in defeating a number of regressive medical liability bills that would have dramatically raised the medical malpractice premiums paid by physicians, including: the date discovery bill (A.1056-A/S.7130), which would amend the current statute of limitations from 2 ½ years from the date of the injury to 2 ½ years from the date that the patient discovered the injury.

Other Insurance-Related Bills
A.978 (Kellner)/S.2708 (Young) – The Assembly Insurance Committee held A.978 for further consideration, which amends insurance law to provide that a group or accident and health insurance policy which provides coverage for physician services must also provide coverage for outpatient care by a mental health counselor, marriage and family therapist, creative arts therapist or psychoanalyst licensed under article one hundred sixty three of the education law. The bill remained in committee in the Senate.

A.5299-B (Pretlow)/S.2360-B (Klein) – The bill permits licensed clinical social workers to provide care and treatment under the workers’ compensation program upon the referral of a physician. A.5299-B passed both Houses.

A.9765 (McDonald)/S.7369 (Hannon) – Supported by MSSNY and the American College of Physicians, the bill amends the Public Health Law to require the New York State Department of Health and the New York State Department of Financial Services to develop a standardized form for requesting prior authorization for prescription medications. Essentially, the bill would expand the use of the standard prior authorization form developed for Medicaid Managed Care to commercial health insurance products. The bill advanced to the Assembly calendar but was not voted on before the Assembly adjourned. The Senate bill remained in committee.

Other Bills of Note
A.10071 (O’Donnell)/S.7818 (Young) – Mental Health Discharge Planning for Inmates of State Correctional Facilities – Spawned by the recent case of a man who was released from prison and subsequently stabbed two Brooklyn children, one fatally, Assemblyman Daniel O’Donnell (D-Manhattan), Chair of the Assembly Committee on Correction, and Senator Catharine Young (R-Olean), S.7818 passed both Houses requiring mental health discharge planning for inmates who have received mental health treatment within three years of their anticipated release from a state correctional facility. As part of the discharge planning, the legislation requires “when necessary” that an inmate be provided with an appointment with a mental health professional in the community who can prescribe medications following discharge and a sufficient supply of medications “to bridge the period between discharge and such time as such mental health professional may assume care of the patient.” The legislation also permits inmates who have refused mental health treatment while in a state correctional facility to be provided with discharge planning. In addition, the bill authorizes regional community supervision directors, as designated by the Commissioner of the Department of Corrections and Community Supervision, to initiate involuntary commitment proceedings under the Mental Hygiene Law.

A.9610-B (Gottfried)/S.7234-B (Krueger) – Maternal Depression – Under S.7234-B, the Commissioner of Health, in consultation with the Commissioner of Mental Health, is to make available to maternal health care providers, including a physician, midwife, nurse practitioner, or physician assistant, or a health care practitioner acting within his or her lawful scope of practice who attends to the mother or child  up to a year after childbirth, information on maternal depression, which is to include (as outlined in the bill): a summary of current evidence-based and professional guidelines for screening; validated, evidenced-based tools for screening; information about follow-up support for those requiring further evaluation, referral or treatment, including information about community resources and entities licensed by the Office of Mental Health; and information on engaging support for the mother. This information is to be posted on the Department of Health’s website and is to be updated “as necessary.” Furthermore, the legislation amends the insurance law to clarify that no insurer shall limit access to screening and referral for maternal depression by requiring a referral from primary care practitioner. S.7234-B passed both Houses.

S.5986-B (Libous)/A.8294-B (Lupardo) – OMH/OPWDD Facility Closures – Known as the “freeze unsafe closures now act,” this bill would postpone the closures and consolidation of state facilities operated by the Office of Mental Health and the Office of People with Developmental Disabilities until April 1, 2017. An agreement was reached with the Governor’s office following the Senate’s unanimous passage of the bill. The agreement reached reportedly includes informing local mental health agencies of discharges and relocating any patients that will remain in the state’s care to other state-run facilities. The Assembly sponsor of the bill shared the agreement reached with the Governor’s office, which focuses on OPWDD facilities and concludes with a plan to convene work group “of representatives from public employee unions to put together a long term plan on how we will provide mental health and developmental disability services in the future, including ways in which state-run services can be preserved.”