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. 


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


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.   


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 amountsThis initiative is expected to result in significant cost-savings for the Medicaid program, since, in many cases, pharmacies charge per pill dispensed.


CMS Announces 2014 RVU Values Substantially Increased for Psychotherapy Add-on Codes

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. 


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


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


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.


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


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 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. Kroplick Named NYSOM's Physician of the Year

Lois Kroplick Receiving Award

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.  


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.


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.


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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. 


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. 


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.


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.

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