120.899 Private Payor Payment Integrity MSSNY shall advocate for the NYS Department of Financial Services to require, at a minimum, private health insurers to pay for diagnosis and treatment options that are covered by government payers such as Medicare and that private insurers shall not be allowed to deny payment for treatment options as “experimental
120.898 Prior Authorization Reform The Medical Society of the State of New will advocate for practicing physician representation in peer-to-peer reviews and development of prior-authorization criteria and also to prohibit the use of prior authorization for medically necessary services and imaging performed during pre-approved surgeries or other invasive procedures. (HOD 2020-270)
120.897 Reducing Prior Authorization Burden and Separate Payment When Not Part of a Patient Encounter The Medical Society of the State of New York (MSSNY) will seek legislation or regulation that: -restricts insurers from requiring prior authorization for generic medications, -ensures the legislation or regulation contains disincentives for insurers demanding unnecessary prior authorizations, including payments to
120.896 Insurance Claims Data The Medical Society of the State of New York (MSSNY) will seek legislation and regulation to promote open sharing of de–identified health insurance claims data. MSSNY will introduce a resolution to the AMA HOD to seek legislation and regulation to promote open sharing of de-identified health insurance claims data. (HOD 2020-260)
120.895 Insurance Coverage for Scalp Cooling (Cold Cap) Therapy MSSNY will seek by legislation and/or regulation, universal insurance coverage for Scalp Cooling (Cold Cap) Therapy. MSSNY will work with consumer groups to challenge insurers on Scalp Cooling (Cold Cap) Therapy medical necessity denials and encourage appeals to independent third-party reviewers. The resolution will be sent
120.894 Prohibition of Insurer Processing Fee on Claims MSSNY will advocate through legislation, regulation or other appropriate means, that health insurers be prohibited from charging physicians and other providers to process claims and make payments. This resolution will be sent to the AMA. (HOD 2021-251)
120.893 Fifteen Month Lab Orders MSSNY will advocate for legislation and/or regulation for all insurances to allow any standing laboratory order to be valid for up to 15 months before a new order is required. MSSNY will submit a resolution to the AMA seeking action by the Centers for Medicare/Medicaid Services (CMS) to allow standing
120.891 Enforcement of Administrative Simplification Requirements – CMS The Medical Society of the State of New York takes the position that the AMA must advocate that: there is parity in the enforcement of the HIPAA Privacy Rule and HIPAAA Administrative Simplification requirements; and that the CMS impose penalties on health plan violations of HIPAA with
120.890 We’re Mad as Hell and We aren’t Going to Take it Anymore MSSNY will aggressively work with county and specialty medical societies across the State to collect examples of health insurers inappropriately denying payment for care, appropriately delaying patient access to needed treatment and abusive audit practices for redress by
120.889 Abolish “Preferred” Status of Laboratories The Medical Society will advocate for health insurers to have comprehensive networks for delivery of lab services that ensure meaningful choice for physicians and affordability and accessibility for patients. (HOD 2022-58)
