New York ACEP Legislative Accomplishments 2024-1995

• Defeated a proposal to penalize hospitals for preventable emergency department visits. The proposal established a Statewide General Hospital Quality Pool and authorized the Department of Health (DOH) to create a penalty pool by establishing performance targets for hospitals to reduce potentially preventable emergency department visits and to reduce or eliminate reimbursement to hospitals based on their quality and safety score was determined by DOH.
• Successfully supported the extension of the Excess Medical Malpractice Program until June 30, 2019 at level funding of $127.4 million.
• Averted proposed cuts for Poison Control Centers.
• Defeated three separate proposals to prohibit balanced billing of emergency services when a patient elects to assign benefits to an out-of-network (OON) health care provider. Two bills were introduced to prohibit balanced billing. A third bill pertained to adding hospitals to the Independent Dispute Resolution (IDR) process also included a provision to prohibit balance billing of emergency services. At New York ACEP’s request the bill sponsors amended their bills to remove the prohibition on balanced billing.
• Defeated legislation that required “every emergency room or hospital practitioner to consult the PMP registry when treating a patient for a controlled substance overdose and to notify the patient’s prescriber of such overdose.”

• New York ACEP advocacy efforts prevent a $20 million cut in ED reimbursement.
  The Governor’s proposal to cut $20 million from the Medicaid budget for “Avoidable ED Visits” was rejected in the final budget.

• Helped pass legislation which relieves practitioners of a burdensome and unnecessary requirement to email documentation of e-prescribing exceptions to the Bureau of Narcotics Enforcement (BNE). The bill allows doctors to make a notation in the patient’s health record regarding any exception taken to the electronic prescribing mandate. The change will help practitioners and hospitals focus on patient care rather than paperwork.
• Helped to defeat legislation to change the statute of limitations for medical, dental and podiatric malpractice from two and half years to “Date of Discovery”; and increase the cap on attorney contingency fees for malpractice action.
• Successfully defeated a provision to eliminate a provision of the original I-STOP laws that exempt prescribers in emergency departments from consulting the Prescription Monitoring Program (PMP) when no more than a five-day supply of a controlled substance is prescribed.

• Helped to defeat legislation to change the statue of limitations for medical, dental and podiatric malpractice from two and half years to “Date of Discovery”; and increase the cap on attorney contingency fees for malpractice action.
• Helped to defeat legislation to require three hours of continuing medical education mandated every two years in pain management, palliative care, addiction prevention and end of life care.
• Worked with others to delay for one year the March 27, 2015 implementation of electronic prescribing mandate that was enacted in 2012 as part of the Internet System for Tracking Over-Prescribed/ Prescription Program (I-STOP).
• Supported legislation enacted to include emergency medical service paramedics and technicians among those professionals against whom an assault with the intent to cause physical injury is a Class D felony offense.
• Helped pass the restoration of funding for the Excess Medical Malpractice Program to $127.4M.

• New York ACEP scored a major victory in the 2014-2015 State Budget by getting an amendment to the out-of-network insurance bill to exempt certain emergency services for the Independent Dispute Resolution (IDRE) process for bills that are less than $600 (annually adjusted for inflation) and do not excess 120% of UCR for evaluation, management and most observation care provided by emergency physicians. The legislation did not prohibit balanced billing for out of network emergency services. Responsibility is placed on the insurance company to negotiate with physicians to ensure that the patient receives no greater out-of-pocket costs than they would have incurred with a participating health care provider. Usual and customary cost (UCR) defined as the 80th percentile of all charges for health services performed by a provider in the same or similar specialty and provided in the same geographic area as reported by a benching marking database maintained by a nonprofit organization by the DFS Superintendent (Fair Health).
• Helped to defeat legislation to change the statue of limitations for medical, dental and podiatric malpractice from two and half years to “Date of Discovery”; and increase the cap on attorney contingency fees for malpractice action.
• Helped to defeat legislation to require three hours of continuing medical education mandated every two years in pain management, palliative care, addiction prevention and end of life care.

• Helped to defeat legislation eliminating the requirement for written collaboration agreements and practice protocols between nurse practitioners and physicians.
• Helped to defeat legislation to change the statue of limitations for medical, dental and podiatric malpractice from two and half years to “Date of Discovery”.

• Achieved an exemption to the Prescription Monitoring Program/New York State Internet System for Tracking Over-Prescribing (I-STOP) for prescriptions written in the Emergency Department for 5 days or less.
• Defeated legislation that would have eliminated the requirement for a written collaborative agreement and practice protocols between nurse practitioners (NPs) and physicians.

• The ACA compliance bill amended the definition of emergency condition in existing state law to delete the requirement that the “onset of the condition must be sudden.” Additionally, the bill conforms to the ACA by inserting the term “acute” before the term “symptoms” in the definition of emergency conditions. New York ACEP met with State Insurance Department and the Department stated that the term “acute” includes the exacerbation of a current or chronic condition and that it did not mean that the underlying disease or condition must be acute.
• Worked with the medical community to secure a total of $127.4 million to continue to fund the physician excess malpractice program.
• Worked to defeat a number of regressive liability measures that would have created a date of discovery rule for the statue of limitations estimated to increase premiums by 15%; expanded wrongful death damages estimated to increase premiums by 53%; permitted the awarding of pre-judgment interest estimated to increase premiums by 27% and eliminated the limitations on contingency fees estimated to increase premiums by 10%.

• Successfully supported legislation to require no fault insurance coverage of emergency services provided to uninsured patients regardless of whether they were injured while driving intoxicated.

• Worked with the medical community to enact a series of managed care reforms including: require that a provider be given notice of an adverse reimbursement change to a provider contract and an opportunity to cancel the contract; require insurers who offer comprehensive policies to offer the same grievance procedures and provide the same access to care that is required for health maintenance organizations (HMOs); require insurers and HMOs to pay electronic claims promptly and limit their ability to respond to claims by sending a coordination of benefits questionnaire; extend overpayment recovery protections to all health care providers and permit them to challenge such recoveries; require insurers and HMOs who fail to meet loss-ratio requirement to make efforts to locate and pay dividends or credits to former policy holders; prohibit insurers and HMOs from treating a participating provider as a non-participating provider; permit newly licensed providers and providers moving to New York to be provisionally credentialed until the final credentialing determination is made by the insurer or HMO; shorten utilization review timeframes for determinations involving post-hospital home health care services; allow providers to appeal concurrent adverse determinations through the external appeal process and establish a new external appeal standard for rare disease treatments.

• Worked with coalition partners to successfully pass legislation to extend the medical liability rate freeze for another year until June 2010.
• Worked with coalition partners to successfully defeat statute of limitations changes.

• Introduced legislation to reduce hospital crowding in both the Assembly and Senate and secured 31 Assembly co-sponsors.

• Secured an increase in Medicaid reimbursement for emergency medical service fees from $12 to $25 which passed in both houses. Governor Pataki vetoed the fee increase claiming that it was unconstitutionally submitted by the Legislature. Worked to successfully secure a legislature override to the veto.

• Introduced legislation to reduce hospital crowding Introduced in the Assembly; along with New York State DOH outreach to hospitals on crowding.
• Defeated an insurance industry aggressive campaign to enact either by regulation or legislation, a proposal to limit reimbursement for out-of-network emergency care.
• Supported with coalition partners an allocation of $2.5 million to partially restore Medicaid crossover payments to physicians who provide services to individuals who are dually eligible for both Medicare and Medicaid.

• Defeated Legislation to Prohibit Balanced Billing of Emergency Services.
• Medical Liability Reform Bill Introduced In Both Houses.
• Legislation Affording Physicians Greater Due Process by OPMC Passed by Both Houses.

Full Restoration of “Medicaid/ Medicare Crossover” budget cut in Medicaid reimbursement for services provided to persons who are “dually eligible” (restored $2.5 million of “Medicaid/Medicare Crossover Cut”).

Successfully opposed listing the American Association of Physician Specialties (AAPS) affiliates or any certifying organizations not recognized by ACEP under the category of “Board Certification” on the New York State Physician profile. (Regulatory 2003)

Helped to defeat $266.2 million in Medicaid cuts to eliminate the State’s responsibility to pay for Medicare cost-sharing obligations for individuals who are eligible for both Medicare and Medicaid. These “cross-over” payments for “dual eligible” (individuals eligible for both Medicare and Medicaid) amounted to approximately $29 million.

Worked with the Department of Health to address increased demand for emergency services by hospitals in some areas of the state resulting in the DOH sending a letter to all hospital administrators January 25, 1999 reminding them of hospital responsibilities during periods of increased demand for emergency services to reduce ED crowding payment.

Introduced and passed legislation to make it a Class D felony to assault emergency medical personnel in the emergency department. The law amends the State Penal Law to include the intentional preventing of hospital emergency department personnel from performing a lawful duty within the crime of assault in the second degree.

Successfully supported legislation to provide for expanded eligibility and services covered under the Child Health Plus program.

Successfully supported legislation affording physicians greater due process by OPMC.

Successfully supported legislation to provide for increased access in public spaces to automated external defibrillators.

Supported Prompt Pay Law requiring HMOs and insurers to pay undisputed claims and bills within 45 days of receipt – ensuring the prompt, fair and equitable payment of patient and provider claims and bills.

Patient Bill of Rights and Medicaid Managed Care Bill of Rights
– established prudent lay person definition
– no preauthorization needed for emergency care
– no retrospective denials based on diagnosis

Filed suit against the State of New York due to refusal of State to reimburse Medicaid patient professional fees as part of HCRA. New York ACEP had legal counsel take case to deposition stage until legislature repealed and provided retroactive payment.