120.876 Guiding Principles for the Healthcare of Migrants MSSNY will advocate for the development of adequate policies and/or legislation to address the healthcare needs of migrants and asylum seekers in cooperation with relevant legislators and stakeholders based on the following guiding principles, adapted from the High-level meeting of the Global Consultation on Migrant Health, i.e.
120.877 Full Transparency – Explanation of Benefits MSSNY will advocate legislation and regulations that mandate that explanation of benefits, whether sent to the patient or the physician practice, include the actual CPT codes billed, DRG-codes, CPT descriptions, and optional consumer-friendly descriptions; and EOB must list the actual allowed amount, patient responsibilities (copay, deductible, coinsurance), non-covered
120.878 Transparency – Non-Payment for Services to Patients with ACA Exchange Plans with Unpaid Premiums MSSNY will advocate for legislation to require that health plans inform healthcare providers whether the plan premium has been paid and whether the account is late on payment as part of benefit verification, whether by phone, fax, or electronic transaction,
120.879 Mandated Economic Escalators in Insurance Contracts The Medical Society of the State of New York (MSSNY) will advocate through legislation or regulation for the mandatory insertion of an economic escalator provision in all commercial insurance contracts to account for economic inflation or a decline in Medicare Physician Fee Schedule (PFS). MSSNY shall bring a
120.880 AI In Insurance Claims MSSNY supports:(1) transparency standards which allow for the state agency auditing of AI algorithms used by New York State health insurers to approve and deny claims (2) the modification of New York statute to explicitly preempt the utilization of race and race-based proxies in the algorithmic claims processing of health
120.881 Do Not Penalize Primary Care Incentives if Patients Refuses Screening Tests MSSNY and the AMA will lobby to propose legislation to the Department of Financial Services and Department of Labor (DOL) to cover fully and self-insured plans in order to revise the punitive practice that health insurances hold Physicians responsible for the sole actions
120.882 Inappropriate Use of the Federal IDR Process The Medical Society of the State of New York will work with the American Medical Association to ensure enforcement of state and federal laws that permit patients to consent to receive treatment from an out of network physician without it being deemed a surprise medical bill. (HOD
120.887 Advocating for a Prompt and Fair Federal IDR Process for Out-of-Network Disputes MSSNY will advocate, and ask the AMA to advocate for, a prompt and fair federal IDR process that includes: (1) timely processing of claims; (2) directions to the IDR entity that no one data point is deemed in advance to be more
120.886 Elimination of the Median in-Network Rate from Consideration at State Independent Dispute Resolution MSSNY will advocate for (1) absolute clarity in how the median in-network rate is being calculated; (2) a requirement that insurers provide the median in-network rate in their EOBs to out-of-network providers if they wish to use this rate as a
120.885 Restore NYSHIP IDR venue back to State Level MSSNY will continue to advocate that out of network surprise medical bills resulting from care provided to patients insured by the New York State Health Insurance Plan (NYSHIP) should be adjudicated by the New York State Independent Dispute Resolution process. (HOD 2023-54)
