195.000 MEDICARE

195.909        Lack Of Access To Standard Of Care, Opioid Sparing, Evidenced Based   Interventional Treatments For Chronic Pain In Medicaid Beneficiaries MSSNY will develop a policy stating that managed Medicaid administrative reform which requires private administrators to follow Medicare NCD (National Coverage Determinants)/LCD (Local Coverage Determinants) guidelines for coverage determinations among Medicaid beneficiaries and prohibits them

(See also Drug Dispensing, 70.000; Drugs and Medications, 75.000; Health Insurance Coverage, 120.000; Health System Reform, 130.000; Medicaid, 175.000; Peer Review, 225.000)   195.911           Care Management and Social Workers MSSNY will advocate for legislation that requires private insurers, Medicaid Managed Care Plans, and Medicare Advantage Plans to have both care managers and social workers assigned

195.999             Mandatory Acceptance of Medicare Assignment: SUNSET HOD 2024

195.998              Mandatory Acceptance of Medicare Assignment as a Condition of Licensure/Re-licensure:  SUNSET HOD 2013

195.997              Fair Hearing: SUNSET HOD 2013

195.996           Medical Necessity Determinations:  MSSNY is urging the Centers for Medicare and Medicaid Services to require Medicare carriers to provide physicians with the name and phone number of the physician responsible for making a determination as to the medical necessity in the initial letter of inquiry sent by the carriers. (Council 9/13/90; Reaffirmed 2009-259; Reaffirmed

195.995             Extrapolation Methodology in Medicare and Medicaid Postpayment Review: MSSNY is: (1) Petitioning the AMA to urge HCFA to adopt a policy that Medicare carriers just provide data which justify the statistical validity of their findings when any extrapolation technique is used in a Medicare post-payment audit and review

195.994            Electronic Paper Claims: SUNSET HOD 2014

195.992            Beneficiary Identification System SUNSET HOD 2014

195.991               Mandatory Enrollment of Medicare – Medicaid Patients in Managed Care Plans MSSNY strongly opposes mandatory enrollment of Medicare-Medicaid patients in managed care plans, and will actively use any available means to prevent forced enrollment and will bring this resolution before the next American Medical Association House of