Assembly Health Committee Update
Protecting nursing home residents from abuse of psychotropic drugs
May 10, 2015

The Assembly Committee on Health favorably reported 39 bills at its meetings in May. The Committee advanced legislation strengthening the “prescriber prevails” rule in Medicaid Managed Care; authorizing community paramedicine; and protecting nursing home residents from overuse of psychotropic drugs.

New York law gives patients in nursing homes the right to be fully informed of their proposed treatment, including the right to refuse treatment and be free from chemical restraint unless consistent with certain requirements. However, psychotropic drugs are being used not just to treat illness but as a form of behavioral control. The Assembly Health Committee held a hearing in February in which patients’ families, advocates, and adult care experts testified to the frequency of overuse. A.7351 (Gottfried) requires that before psychotropic drugs are ordered in a nursing home or adult care facility, the patient or their surrogate must be informed of the potential benefits and side effects; dosage and duration of the prescription; reasonable alternatives (such as therapeutic activities); and their right to refuse consent. The bill also requires written consent by the patient or surrogate.

For more information on a particular bill, please contact the sponsor listed after the description. For the text of a bill, supporting memorandum, and information on its status, go to: http://public.leginfo.state.ny.us/menuf.cgi.

Tuesday, May 5

Early Intervention Covered Lives Assessment – Provides funding for Early Intervention services through the “covered lives assessment” paid by health insurance companies. (A273, Paulin)

Credentialing for Group Practices - Requires insurers to expedite review of applications of health care professionals who are joining a group practice and grant provisional credentials to these professionals (A501, Cusick)

Healthy Teens Act – Establishes a Department of Health grant program for providers of age-appropriate sex education. (A1616, Gottfried)

Birth/Death Certificate Fees - Albany - Permits the city of Albany to set the fee it charges for issuing a birth or death record. Currently, State law sets the fee at ten dollars. (A3052, Fahy)

Birth/Death Certificate Fees - Jamestown - Permits the city of Jamestown to set the fee it charges for issuing a birth or death record. Currently, State law sets the fee at ten dollars. (A5097, Goodell)

Spina Bifida Education and Outreach Program - Authorizes the Department of Health to establish a spina bifida education and outreach program. (A6979, Ortiz)

Standardized Prior Authorization Forms – Reduces the administrative burden on health care providers by requiring insurance companies to utilize standardized prior authorization forms. (A6983, McDonald)

Tuesday, May 12

Pharmacy Payment Appeals – Pharmacy benefit managers (PBMs) manage pharmacy benefits for health plans and employers and pay pharmacies for submitted claims. For generic medications, payments from PBMs to pharmacies include a “maximum allowable cost” (MAC). But since each patient’s insurance policy may be subject to a different MAC, a pharmacy typically does not know how much they will be reimbursed before they fill a prescription. So this bill requires contracts between pharmacies and PBMs to include a process by which the pharmacist can appeal a payment that is below its cost. (A676B, Rosenthal)

Pain Management Protection - Protects health care professionals from criminal liability and professional discipline for prescribing and administering pain medication when they act within accepted professional standards. Physicians and others are sometimes reluctant to prescribe appropriate pain management out of fear of wrongful prosecution. (A2230, Gottfried)

Preventing Lead Exposure – Increases the penalties against landlords and others for lead abatement violations. (A4466, Clark)

Local Input in Community Healthcare Act – Requires a thorough process of community input including a timeline and report before the Commissioner can approve a hospital closure application. (A6417, Simon)

Artificial Trans Fat Ban - Protects consumers from the detrimental health effects of artificial trans fats by prohibiting certain restaurants and food establishments from serving or preparing foods with artificial trans fats. This statewide bill is modeled on New York City law. (A7109, Ortiz)

Safe Sleep Information – Requires that information provided by hospitals and birth centers to maternity patients include recommendations from the American Academy of Pediatrics relating to safe sleep, including sleep space and sleep position. (A7181, Paulin)

Breastfeeding Mothers’ Bill of Rights – Updates the existing “Breastfeeding Mothers’ Bill of Rights,” a document posted in maternal healthcare facilities, nurseries, and post-delivery recovery rooms, to include the right to take reasonable unpaid breaks at work in order to pump breast milk. (A7202A, Gunther)

Prescriber Prevails in Medicaid Managed Care – Under fee-for-service Medicaid, a health care practitioner writing a prescription prevails if he or she prescribes a drug different from the one Medicaid prefers. However, it is unclear whether similar rules exist for patients in the Medicaid managed care program in the event of denials by the patient’s managed care plan. This legislation ensures that Medicaid managed care patients have the same protections as in fee-for-service. (A7208, Gottfried)

Impaired Physician Programs – The Medical Society’s Committee for Physicians’ Health currently provides treatment and counseling to NYS physicians thought to be suffering from alcoholism, substance abuse, or mental illness. Physicians who provide services in the program have liability protection. However, a recent lower court decision has interpreted these protections as not applying to the Medical Society itself. This legislation clarifies that the liability protection applies to the Medical Society. (A7267, Gottfried)

Tuesday, May 19

Crib Safety Information – Requires hospitals and birth centers to distribute information on crib safety including sleeping procedures for babies and crib product recall information. (A356, Rosenthal)

Tattoo & Body Piercing Safety – Requires single use needles and inks to be used by tattoo and body piercing establishments. (A1334, Zebrowski)

Regulating Retail Clinics – Retail clinics currently exist throughout NY, providing episodic care as an alternative to emergency rooms. However, there is no statutory or regulatory system in place to govern their practice. This bill ensures that all retail clinics be subject to set standards in order to ensure they provide safe, high quality, integrated health care. With the regulations in place, the bill would allow the retail company to own the clinic under Public Health Law Article 28, as an alternative to leasing space for it. (A1411A, Gottfried)

Lupus Research Program and Fund – Establishes an advisory council and fund within the Department of Health to make grants to state academic medical centers for lupus research. (A2631, Peoples-Stokes)

Lupus Education and Outreach – Establishes a lupus education and outreach program within the Department of Health to raise public awareness and educate patients and health care professionals. (A3072, Peoples-Stokes)

Disability Clinic Funding – The 2011 state budget imposed a 2% reimbursement cut to health care providers as a cost-savings measure. Article 16 clinics, which provide services to individuals with disabilities, were not cut in this way but instead had utilization caps placed on them. The 2014 budget restored the 2% cut and authorized the Department of Health to lift the utilization caps, which punish providers who serve individuals with the most severe disabilities. However, the Department chose not to lift those caps. This legislation does. (A7327, Gunther)

Psychotropic Medications in Nursing Homes –This bill requires that before psychotropic drugs are ordered in a nursing home or adult care facility, the patient or their surrogate must be informed of the anticipated benefits and side effects; dosage and duration of the prescription; reasonable alternatives (such as therapeutic activities); and their right to refuse consent. The bill also requires written consent by the patient or surrogate. (A7351, Gottfried)

Dental Telehealth Services – Telehealth programs can dramatically increase access to health services for patients in rural areas or with mobility restrictions. This bill amends existing telehealth legislation to include dentistry. (A7369, Russell)

Conflict-of-Interest Law Reform – Federal and New York state laws prohibit kick-backs and other arrangements in which one health care provider benefits financially from referring a patient to another provider. The bill provides that if an arrangement would be allowed under the Federal law, it would also be allowed under the New York law unless the Public Health and Health Planning Council rules otherwise. (A7374, Pichardo)

Sepsis Data Collection – In 2013 New York became the first state to require data collection and reporting on sepsis in hospitals. While it is possible for organizations to publish this data today, the results are likely to be misleading since the data set does not adjust for patient mix, sepsis severity, or reflect patients not eligible for treatment due to advance directives. This bill would allow the Department of Health up to two years to complete data collection and develop appropriate analytics before publication. (A7465, Gottfried)

Physical and Occupational Therapy Telehealth Services – Telehealth programs can dramatically increase access to health services for patients in rural areas or with mobility restrictions. This bill amends existing telehealth legislation to include physical and occupational therapy. (A7488, Russell)

EQUAL Funding Reimbursement – The Department of Health provides Enhancing the Quality of Adult Living (EQUAL) funds to adult care facilities for purposes such as facility improvements. Because EQUAL funding often occurs late in the fiscal year, operators often cannot wait until the actual issuance of funds to pay for items or improvements. This bill allows the operator, with approval of the resident council, to apply EQUAL funds retroactively. (A7502, Gottfried)

Community Paramedicine – This bill authorizes "community paramedicine" (CPM), the provision of health care by emergency medical technicians in circumstances other than the initial emergency care and transport. This may include coordinating care information with other providers; referring frequent emergency callers to appropriate services to break the cycle of relying on EMS calls; or evaluating potential health hazards in the patient’s home. CPM has been recommended by the NYS Emergency Medical Services Council and Emergency Medical Advisory Committee as a way to improve care for patients who currently over-rely on episodic 9-1-1 calls for their care. (A7503, Gottfried)

Thursday, May 28

Protection from Radon Exposure – Natural gas distributed to consumers includes radon and potential other radioactive substances. The level varies from one gas production site to another. This bill increases the public’s safety by requiring the commissioner of health to monitor radon levels and provide standards for gas companies; requiring gas companies to establish radon mitigation programs; and establishing a right of civil action for non-compliance. (A778, Rosenthal)

Meningococcal Immunizations – Requires meningococcal vaccinations for students entering seventh and twelfth grades, as recommended by the Advisory Committee on Immunization Practices within the federal Centers for Disease Control and Prevention. (A791A, Gunther)

Anatomical Gifts to Medical Schools – The law allows medical schools to receive unclaimed cadavers for medical education. These programs are critical to New York State’s 16 medical schools. However, current law also requires that only licensed funeral directors using a funeral home registration number may file the required permits. This bill streamlines the process by allowing educational institutions to file the required paperwork themselves. (A2626A, Peoples-Stokes)

Prohibiting Tobacco Coupons – Discount coupons for tobacco products undermine the state’s anti-smoking programs and are particularly attractive to young people. This bill prohibits the offering of such coupons. (A5164A, Mayer)

Physical Fitness Education Program – Establishes a physical fitness and activity education campaign within the Department of Health. (A7022, Cusick)

E-Cigarettes on School Grounds – Prohibits the use of e-cigarettes on school grounds. (A7154A, Rosenthal)

Improving the Organ Donation Process – Lauren’s Law, named for a girl whose life was saved by a heart transplant, allows driver’s license applicants to choose to become organ donors by checking a box on their application. However, applications that leave the donation section blank entirely – rather than checking the available “yes” or “skip this section” choices – are not automatically invalidated. This has greatly reduced the number of people who check either box. This bill fulfills the intent of Lauren’s Law by preventing any driver’s license application from being processed if the organ donation section is not completed one way or another. (A7431, Ortiz)

Consumer Directed Personal Assistance Program Fiscal Intermediaries – The Consumer Directed Personal Assistance Program (CDPAP) allows Medicaid enrollees to directly hire personal care assistants. With a significant recent growth in enrollment, an industry has emerged to provide services handling payroll for these assistants while leaving care coordination to the patient. However, these fiscal intermediaries are one of the only entities in health care that are not regulated or licensed in any manner. This bill defines the term “fiscal intermediary” and sets out licensing guidelines. (A7535, Gottfried)

Early Intervention Program Reporting – The 2012-13 state budget eliminated the annual “New York State Early Intervention Report to the Legislature.” Since then the Department of Health has provided various information on its website, to the Federal government, and at meetings of the Early Intervention Coordinating Council. However, some data is no longer made available and other information can be difficult to find. This bill reinstates an annual reporting requirement including much of the information that was previously included. (A7554, Jaffee)

Traumatic Brain Injury Transition Delay – Individuals with traumatic brain injury currently receive services from specialized providers under the nursing home transition and diversion (NHTD) and traumatic brain injury (TBI) waivers. However, the NHTD and TBI waivers are scheduled to be eliminated and these populations moved into Medicaid managed care in January and April 2016 respectively. Given the sensitivity of these populations, this bill delays the transition for a year while establishing a process for stakeholders including patients’ families, providers, and payers to provide input into a transition plan. (A7598, Gottfried)