On December 28, 2017, The New York State Workers' Compensation Board (Board) announced the establishment and release of a proposed Pharmacy Formulary.
Governor Cuomo signed into law in April 2017 legislation that required the Board to establish a comprehensive prescription drug formulary by December 31, 2017.
Publication in the State Register on December 27, 2017 commences a 60-day comment period (which expires on February 26, 2018). The draft formulary and the associated regulations necessary for implementation are available on the Board's website.
The current draft proposes a July 1, 2018 effective date. However, the drug formulary and regulations will not become effective until the regulations are adopted and a final implementation date has been determined.
The NYSSOS Board of Directors is reviewing the proposal at its January meeting. Anyone interested in sharing your feedback with the NYSSOS Board to be considered for incorporation with the Society's response, is asked to submit comments to: email@example.com
If you'd like, you can directly submit you comments on or before February 26, 2018. This includes requests to add/delete pharmaceuticals to the preferred list of the prescription drug formulary.
The Board will evaluate all comments received, and will consider necessary revisions as the process advances.
As Posted by the New York State Workers' Compensation Board on December 28, 2017: http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1011.jsp
Workers' Compensation law §15(3)(x), enacted as part of the 2017 executive budget, called upon the Board to implement new Permanency Impairment Guidelines for Scheduled Loss of Use (SLU) evaluations, with an effective date of January 1, 2018.
The Board announced the SLU Guidelines have been adopted, and are available on the Board's website. The enabling regulation is set forth at 12 NYCRR 325-1.6, and is also available at the Board's website.
NYSSOS believes and advocates that properly designed and efficiently run workers compensation programs can provide high-quality health care to injured workers and minimize their disabilities. NYSSOS is extremely appreciative for the unique opportunity to provide substantial contributions during the process.
However, NYSSOS is deeply disappointed in the substantial changes and deviations in methodology from the original proposal that NYSSOS submitted for consideration.
We invite you to share with us any issues or concerns that arise from using the new guidelines. They will be reported back to the NYS WCB.
The 2018 SLU Guidelines will replace chapters in the existing 2012 Medical Impairment Guidelines with respect to SLU, and will take effect January 1, 2018. The 2012 Guidelines remain unchanged for determining non-schedule permanent impairments.
For SLU claims that have at least one examination conducted before January 1, 2018, the Board will consider the issue of SLU to have been joined under the auspices of the Guidelines in effect at the time, and as such the Board will determine the claimant's degree of permanent disability using the 2012 Guidelines. Where the first medical evaluation of SLU occurs on or after January 1, 2018, the question of SLU will be evaluated under the 2018 SLU Guidelines.
By: John Cherf, MD, MPH, MBA, and Alex Paul
The United States has the highest per capita healthcare spending in the world. U.S. healthcare costs have outpaced inflation for several years. Over the past 20 years, the federal government has attempted to control costs—specifically Medicare costs.
Cost reduction strategies often focus on specific segments of the healthcare market. These segments include hospitals, outpatient facilities, labs, drugs, physicians, rehabilitation, durable medical equipment, etc. Medicare has unique fee schedules for the various segments of the healthcare economy. The annual changes to these various fee schedules have not been uniform.
The most striking finding among various provider fee schedule changes was the Medicare Physician Fee Schedule (MPFS), which controls how physicians are paid by Medicare...> Read More
Representatives of the American Orthopaedic Foot & Ankle Society (AOFAS) and AAOS were successful in changing legislation that would have labeled all podiatrists at the Department of Veterans Affairs (VA) as "physicians." It also would have raised salaries for podiatrists to make them equal to medical doctors (MD) and doctors of osteopathy (DO) as well as allow them unrestricted access to clinical leadership positions.
Due to their direct intervention, the result was legislation that reinforced the necessity of clinical leadership belonging to MDs and DOs as well as the "physician" title.
That success did not come overnight, however...> Read More
In the complex and busy world of healthcare delivery, physician practices may overlook basic office procedures that promote patient safety and reduce exposure to liability.
This handbook identifies potential risks and provides recommendations to mitigate them.
Each tip is designed to address a common issue in the office practice and provide practical guidance on how to employ best practices.
These easy-to-implement recommendations are a guide for physicians, other healthcare providers, and staff. The implementation of these recommendations may assist in preventing adverse outcomes, improving patient care, and minimizing liability exposure in the office practice.
Access the Guide
In this year's 2017 - 2018 Executive Budget, Governor Andrew M. Cuomo signed into law several significant pieces of workers’ compensation reform which includes new Permanency Impairment Guidelines (“Guidelines”) to be adopted by January 1, 2018.
On Tuesday, September 26, 2017, the New York State Assembly Labor Committee held a hearing to examine the proposal and listen to concerns expressed by stakeholders including, NYS Society of Orthopaedic Surgeons, organized labor, groups representing injured workers and trial attorneys.
For additional information
For more information regarding these proposed regulations, contact Heather M. MacMaster, Deputy General Counsel, Workers' Compensation Board 328 State Street, Schenectady, New York 12305-2318, telephone: (518) 486-9564 e-mail: firstname.lastname@example.org.
MLMIC has released its Fall 2017 issue of MLMIC’s Dateline® newsletter. Published twice a year (spring and fall), Dateline® focuses on risk management issues and improving patient safety, as well as keeping MLMIC policyholders apprised of changes in underwriting procedures, legal matters, legislative affairs, and many other matters of interest to physicians and healthcare facilities
In the Fall issue:
President Trump's administration announced last week that it will immediately end subsidies that insurance companies and New York State receive to help pay for health care for lower- and middle-income people buying insurance on their own.
New York was one of two states (the other was Minnesota) to implement an optional benefit under the ACA known as the Essential Plan within the NY Health Exchange.
The Essential Plan offers health insurance with maximum premiums of $20 a month to New Yorkers who earn more than the limit allowed by Medicaid, up to 200 percent of the federal poverty level, or $27,720 for a single person. About 665,000 New Yorkers are enrolled in the Essential Plan.
For New Yorkers on the Essential Plan, the cost-sharing reductions go directly to the state to cover costs. This year the payments for the Essential Plan totaled about $925 million. Those payments will end if there were no more cost-sharing reductions.
For a full Q and A on the issue, see recent TimesUnion news article by Claire Hughes highlighting the impact.
As proposed in the 2018 Quality Payment Program proposed rule, solo practitioners and groups can choose to participate in the Merit-based Incentive Payment System (MIPS) as a virtual group for the 2018 performance period.
To form a virtual group for 2018, solo practitioners and groups would need to engage in an election process.
For the 2018 MIPS performance period, the election period for virtual groups to make an election is from October 11, 2017 to December 1, 2017.
What is a Virtual Group?
CMS has proposed a virtual group to be a combination of two or more Taxpayer Identification Numbers (TINs) made up of:
How Do I Form a Virtual Group?
To form a virtual group, CMS has proposed a two-stage virtual group election process:
The election would include:
1. A written formal agreement between each of the virtual group members; and
2. Information about the TIN and NPI associated with the virtual group representative’s contact information.
For more information about joining or forming virtual groups, see theVirtual Groups Toolkit.
Need Help with the Election Process?
Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222). You can also contact your local support organization for support.
The Centers for Medicare & Medicaid Services (CMS) has recently posted the following new Merit-based Incentive Payment System (MIPS) resources on the CMS website:
NYSSOS serves the interests of New York orthopaedists and their patients by helping to create an optimal practice environment in which to provide quality and efficacious orthopaedic care.
Address: PO Box 38004, Albany, NY 12203