October 29, 2024

DOH delays law to curtail surprise medical bills following provider backlash

Amanda D’Ambrosio, Crain’s Health Pulse, 10/29

State health officials have tabled a new law designed to protect patients from surprise medical bills following backlash from providers who said it could put them out of business.

The Department of Health has delayed the implementation of a new policy that bans hospitals, medical practices and telehealth providers from holding patients responsible for the full cost of their care before they even receive treatment. The law, which was passed in the state budget in April, was designed to stop providers from making patients sign financial liability forms as a condition of receiving medical services – a widespread practice that has left many patients vulnerable to receiving surprise medical bills, advocates say.

The legislation is one of a series of newly passed laws to protect patients from unexpected medical bills. Although providers argue that regulating patients’ financial consent could create logistical barriers and threaten their businesses, advocates say that delaying the implementation of such a measure is a setback to the state’s effort to curtail surprise bills. Patients are still held accountable for any out-of-pocket costs before they know what their insurer will cover without the protection of the new law, giving health care providers the ability to chase down their medical debts.

“No one should be demanding that patients write a blank check in advance of a service,” said Elisabeth Benjamin, vice president of health initiatives at the nonprofit Community Service Society. “This is how people get medical debt.”Alicia Biggs, a spokeswoman for the Health Department, said that implementation of the law is “under further consideration” while the agency reviews feedback. She added that the agency is working with stakeholders to “ensure that the law is implemented in a way that protects patients without being overly burdensome for providers.”New York’s new financial liability policy was one of a handful of laws in the state budget designed to protect patients from medical debt. But after the budget was passed, lawyers and health care providers raised questions about the ambiguity of the bill language and potential logistical barriers that could harm health care businesses, said Justin Pfeiffer, a health care attorney at the law firm Nixon Peabody who represents health care providers in New York.For example, the new law would require providers to discuss treatment costs with patients before they receive services. But even if a patient understands the costs before getting care, the policy states that they still have the option to say no to payment after the services have been rendered – a circumstance that could leave providers in the red for that care.“If you’re a provider, this sounds absurd, impractical and infeasible,” Pfeiffer said.

Some groups went as far as to say that the new law could put their practices out of business. A group of specialty physician associations —  including the Medical Society of the State of New York, which represents 20,000 licensed physicians, residents and medical students — sent a letter to the Health Department last month stating that the legislation would interrupt practice workflows and increase the number of patients who refuse to pay for care that’s not fully covered by insurance.

“Without revisions to this law, many community physicians may struggle to sustain their practices, maintain staff, or continue providing the level of care their patients expect and deserve,” the organizations said.The concerns spurred the Health Department to put the new law on ice. Health Commissioner James McDonald sent a letter to hospital chief executives on Oct. 18 stating that the agency will not push implementation of the law until it reviews questions about the meaning of the legislation.The Medical Society of the State of New York has donated more than $20,000 to Gov. Kathy Hochul’s political campaign fund in the past two years, state campaign finance records show.Benjamin said that the state should either revisit this legislation or go a step further and require providers to give patients a cost estimate before they receive medical treatment. The federal No Surprises Act requires providers to offer a good faith estimate of the cost of out-of-network care before services are rendered, but New York could expand its rules to apply this to all types of treatments, she said.

N.Y.’s opioid board holds tense meeting ahead of report to Hochul

The conflict began when it was acknowledged that not all members of the board were sent a draft version of the report before they sat down to review it.

ALBANY — A tense meeting of the panel responsible for recommending how New York will spend millions of dollars to address opioid addiction by Nov. 1 was nearly derailed Monday after members criticized the state’s involvement in the process.

That panel — called the Opioid Settlement Fund Advisory Board — even considered adjourning without a vote on those recommendations over discontent with the lack of data it has received from the state.

“I am not prepared to vote on this report because we do not have the data sufficient to be making recommendations,” said board member Tracie Gardner.

The conflict began when it was acknowledged that not all members of the board were sent a draft version of the report before they sat down to review it and vote on its approval. 

The board receives administrative support from staff with the Office of Addiction Services and Support — but the draft version was sent around from an email address that belonged to one of the members. Some were unintentionally left off the list, members said.

“I want to know why (the office) didn’t send out this report for us to review,” Gardner said. “You’re staffing us.”

That led to a larger discussion about the agency’s relationship with the board. Members said they’ve asked for data from the state that would help better inform their decisions but haven’t always received it.

“I, too, have been asking for data literally since the beginning of our first meeting in addition to deaths,” said board member Anne Constantino. “I very much don’t understand the strategy and how money is distributed.”

Other members were more direct. Board member Dr. Justine Waldman said she feels she’s been “gaslighted” by the agency at times when she’s asked for data and other information.

“This has been deliberately a withholding of information from us since year one,” Waldman said. “There has not been collaboration.”

Those comments added a thick layer of tension and unease at the meeting, which was also attended by Dr. Chinazo Cunningham, commissioner of the office.

Cunningham defended her agency, saying it’s given countless presentations to the board with data and information that’s been requested. Recordings of past meetings have documented that work for the board.

“I’m not certain that any amount of presentations or any topic of the presentations would satisfy the board,” Cunningham said. “But, you know, I certainly hear the comments.”

After a few more rounds of discussion, the board reached a consensus to advance the report with their recommendations and work out the other issues at another time — but not without their points being made to the public.

“There should be a page summarizing the dissent, if you will, of board members with the report,” Gardner said. That motion passed.

The report isn’t yet available to the public, though specific sections were discussed at the meeting. The board intends to ask Gov. Kathy Hochul, for example, for a letter declaring a public health emergency over opioid addiction and overdoses.

They also discussed how much of the funding should go into nine different buckets they’ve already agreed on. Those range from harm reduction strategies to grassroots organizing, with the former expected to receive the most out of those categories.

Hochul will then take those recommendations and decide how to apply them to the executive budget she’ll propose to the Legislature. That’s scheduled to be released in January.

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