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AN
ACT to provide additional options for reimbursement
for school based health centers who serve children
covered by the CHIP program.
Memo of Support
for A. 09717/S. 6616
Contact: March 9, 2010
Elie Ward
Director of Policy & Advocacy
eward@aap.net
518-441-4544
The American Academy of
Pediatrics, District II, NYS, representing more than
6,000 pediatricians and the millions of children we
care for across the state strongly supports A.
09717/S. 6616. This legislation provides additional
sources of revenue to support School Based Health
Centers, while maintaining the primacy of the medical
home in the managed care environment.
Allowing School Based
Health Centers to participate in the Facilitated
Enrollment Program, helping to enroll eligible
children in Medicaid and Child Health Plus will help
the state reach even more eligible children and
provide them with vital health care coverage. Creating
the option for School Based Health Centers to bill
Child Health Plus, while requiring timely
communication with the child's community based
physician, will enable many youngsters, especially
adolescents, to have better access to the health and
mental health services that they need.
School Based Health
Centers offer high quality health care services where
children are. They can and should be part of a child's
health care service network as appropriate. For many
years New York has struggled to find ways to continue
to support School Based Health Centers. Their very
existence has been tied to the vagaries of the state
budget more than most other components of the health
care service delivery system. Today, most School Based
Health Centers are related to larger systems of
hospital or community based clinic services. To allow
them to bill for the services they provide to children
in Medicaid Managed Care programs and children in
Child Health Plus programs is not only fair in terms
of paying for services provided, but is also
reasonable in terms of business model which includes
payment for onsite services.
This legislation will
bring much need payments into the School Based Health
Care network of services, with little or no impact on
the state budget, since the children's health care
services are already covered in the Medicaid and Child
Health Plus programs.
The AAP, District II,
NYS urges the Assembly and the Senate to pass A.
09717/S. 6616 this session. And we urge the
Governor to sign the legislation when it reaches his
desk.
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AN
ACT to amend the insurance law, to require health
insurance coverage for the screening diagnosis and
treatment of autism spectrum disorders
Memo
of Support for A.
10372/S.
7000
Contact: March 9, 2010
Elie Ward
Director of Policy & Advocacy
eward@aap.net
518-441-4544
The American Academy of
Pediatrics, District II, NY representing 6,000
pediatricians across the state and the millions of New
York children we care for, enthusiastically supports
A.10372/S.07000.
This legislation amends
Insurance Law to require every health insurance policy
in the State of New York to cover the screening,
diagnosis and evidence based treatment of autism
spectrum disorders. Further, the legislation requires
that New York State use the current and subsequently
published clinical reports and treatment guidelines of
American Academy of Pediatrics as the standard for all
screening, diagnosis and treatment decisions and
coverage for autism spectrum disorder. The AAP
standards will stay in place until such time as the
identified state leaders agree to promulgate statewide
standards. These statewide standards will also be
based on the most recent reports and guidelines of the
AAP. Should the state fail to establish its own
guidelines, the AAP guidelines will remain the
standards for coverage in New York State..
In New York State, the
autism rate for children has been increasing by
approximately 15% per year. Recent studies have shown
that close to 1 in 90 children are affected.
Currently, there are 17,000 students age 4 to 21
classified by New York schools as having autism.
Despite research that
has shown specific evidence based intensive behavioral
therapies can result in significant improvement in the
cognition, communication and functionality of people
with autism spectrum disorder evidence based
screening, diagnosis and treatment have been excluded
from coverage by health insurance carriers here in New
York.
Studies have also shown
that that health services targeted to address the
medical complications and co-morbidities of autism
spectrum disorder can significantly improve physical
and social functioning of children. These medical
services would also be covered under the AAP
standards.
If children are denied
needed intensive early evidence based psycho/social
and medical treatment they will have a lower level of
functionality and are much more likely to need
life-long support services. Cost analyses show that
every dollar spent on early treatment will save $5 to
$7 in long-term costs.
In the absence of
adequate health insurance coverage, the families of
those with ASD bear the costs of treatment. Many of
them do not have the resources to pay for enormous
out-of-pocket treatment and therapy costs which can
run as high as $2,000 to $4,000 per month. The Autism
Society of America estimates that the lifetime cost of
caring for a child with autism ranges from $3.5 to $5
million. Alternatively, the taxpayers pay these costs
through Medicaid and increased demand for highest cost
special education services through our schools.
Information on the real costs for mandatory autism
coverage from Aetna in Texas shows an increase of less
than one tenth of one percent. Actuarial analysis of
legislation introduced in Massachusetts showed an
estimated worst case scenario cost increase of one
eighth of one percent per policy holder.
California, Texas,
Pennsylvania, Florida, Illinois, Montana, Indiana,
Louisiana, Oregon, South Carolina and Arizona, all
have laws requiring health insurers to cover autism
spectrum disorder. Similar legislation is under
consideration in many other states. New York needs to
join other states and provide coverage to children
with autism and autism spectrum disorder. To do less
would be shirking our responsibility to provide high
quality accessible medical care to all children.
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Financial
Base for Medical Homes
Memo of Support
for A. 09917/S. 6956
Contact: March 31, 2010
Elie Ward
Director of Policy & Advocacy
eward@aap.net
518-441-4544
The Academy of
Pediatrics, District II, NYS representing more than
6,000 pediatricians across New York State,
enthusiastically supports A09917/S6956 which supports
the development of and creates a financial base for
Medical Homes. Providing legal authority for the
State Department of Health to approve health care
services networks which include, private,
private/public and purely public health payers and all
providers in a specific area will go a long way to
encourage Medical Homes for all New Yorkers.
Pediatricians have been
advocating "Medical Homes" for their child
patients for many years. In fact, it was the
national American Academy of Pediatrics which first
designed the Medical Home and advocated for its
adoption for all children. The current AAP
Medical Home Model is called Bright Futures. AAP
District II, NYS has been working with all
stakeholders to design and implement a Bright Futures
NY model for several years. This legislation
will help support our ongoing work. It will
allow the development of payment options which could
make Bright Futures Medical Homes a reality for all
children.
Although the AAP
approach focused on the special needs of children,
over the last ten years most other medical groups,
health care advocates, business groups and even some
insurers have come to the conclusion that high
quality, accessible Medical Homes, can meet the
ongoing needs of health care consumers better than the
patchwork system we currently have in place. It
has been demonstrated that Medical Homes can not only
increase the quality of care that people get, but
Medical Homes can also reduce the costs of high level
crisis care by maintaining health care interventions
at appropriate levels in partnership with patients and
patients' families.
But to create and
maintain Medical Homes here in New York requires
health care third party payers to implement payment
methodologies and provide levels of payment that can
support "Medical Home" providers.
Under this legislation,
a program under DOH supervision could bring together
all public and private health care payers and
providers in a specific area to set Medical Home
standards and offer payment levels to enable primary
care providers to meet those standards.
The program would
include support and approval of alternative payment
methodologies and levels of payment reflective of
quality assurance measures. Payments could also be
made to non-profit entities that assist primary care
providers with care management and other services.
Bringing all payers and
providers together for this purpose requires an
exemption from anti-trust laws to enable all parties
to work together legally. Under federal and
state antitrust law, the state can provide a
"state action" exemption from anti-trust
laws for an activity in the public interest that is
supervised and regulated by the state. This bill
would provide that leadership, effort and legal
protection.
Alternative payment
methodologies and other provisions of a high quality
Medical Home program will promote the development of
integrated health care delivery systems in communities
across the state.
We support A09917/S6956
as an important step to support Bright Futures NY and
other Medical Home models for all New Yorkers.
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An
act to amend public health law in relation to
requiring vaccination against meningococcal disease
for seventh graders
Memo of Support
for A.10313/S.7156
Contact: April 6, 2010
Elie Ward
Director of Policy & Advocacy
eward@aap.net
518-441-4544
The American Academy of
Pediatrics, District II, New York State, representing
6,000 pediatricians across New York enthusiastically
supports A.10313/S.7156. This legislation would
require immunization against meningococcal disease at
entry to seventh grade or at the age a young person
would enter seventh grade. Catching students at
this age, while still in school, would give
communities a better chance to actually immunize this
population before it scatters to college or other
congregate living arrangements. It would also
cover young people going off to summer camp as young
campers or as counselors.
Meningitis is a serious
and sometimes lethal disease which often attacks teens
and young adults. It can progress rapidly,
sometimes in a matter of hours, and kill the
healthiest adolescents. Symptoms in the early
stages of the disease often mimic those of more common
and less serious diseases such as flu or colds.
This can make early diagnosis a challenge, especially
among adolescents and young adults who think of
themselves as the "immortals," and often
shun medical attention.
Meningococcal
infectious is usually acquired through intimate
contact with an infected person, including kissing,
sharing foods/beverage, or by coughing/sneezing.
It can spread quickly in congregate living
arrangements like a camp or campus/dorm setting.
Recent studies indicate
that the case fatality rate in adolescents who
contract meningococcal disease could be as high as
20-40%. Among survivors of all ages, 11%-19%
will be permanently disabled as a result of scarring
and limb loss from gangrene, stroke, or central
nervous system symptoms.
Adolescents are at an
increased risk of this disease and have a higher death
rate than most age groups. Many parents are
unaware of this disease and the vaccine that can
prevent it, until it strikes in their community or at
the camp or campus where their teen is living.
We now have an opportunity to begin preventing disease
by driving up immunization rates through school
requirements when the risk of disease begins to
rise---in adolescents entering 7th grade.
Because meningococcal
disease progresses so rapidly and its effects are so
severe (even with appropriate treatment) immunization
of adolescent students would help protect them from
this potentially devastating disease.
The Advisory Committee
for Immunization Practices, which is the CDCs vaccine
advisory board, recommends routine vaccination in
adolescents 11-18 years of age. Mandating
immunization at entry to 7th grade will help protect
adolescents and young adults as they move through
their highest risk age cohort and into their highest
risk living arrangements.
AAP District II urges
passage of this legislation this year, to help protect
teens and young adults across our state.
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American
Academy of Pediatrics, District II
New York State Budget Priorities
Revenues
Taxes on Sugared Beverages, Tobacco & Alcohol
The Academy of
Pediatrics strongly supports the imposition of tax
on sugary syrup in soda, fruit drinks, and sports
drinks as proposed in this budget. We know that
this tax will not solve our epidemic of childhood
obesity. But the tax can and should be a part of what
we do to address this very serious problem.
Imposing a tax on
sugary drinks demonstrates state government's
recognition that we have a childhood obesity epidemic.
Here in New York more than 25% of our children are
obese and almost 40% are significantly overweight. The
current obesity epidemic has the potential to bankrupt
our already teetering health care system.
We believe that we can
and should create public policy which shows that
government cares enough about its children to make
sugary drinks more expensive. We do not pretend that
any such tax will stop the consumption of soda and
sugary drinks. But if such a public policy can reduce
consumption, while at the same time bring vital
revenues into the state's coffers, we cannot see any
down side here. For those who may see this effort as
an overreaching "nanny tax," remember the
huge outcry when tobacco taxes were first proposed.
The beverage industry is big and strong and powerful.
But they don't pay the bills when kids are overweight
and develop diabetes and heart disease before they
even become teenagers.
It is estimated that
New Yorkers already pay more than $8 billion in
obesity related health care costs each year. That
translates into $777 per family each year. So, it is
not truthful to say that to pay tax on sugary drinks
is an additional and unfair burden. Families are
already paying; they just can't see it because it is
in their increased insurance premiums, their increased
costs for co- pays on insurance and their increased
federal, state and local taxes to pay for obesity
related treatments for Medicare, Medicaid and private
insurance. If in fact, if we can reduce consumption
and reduce high health costs associated with obesity
related disease, we may in the end reduce the costs
that families currently bear.
The fear of job losses
is another red herring. The beverage industry in New
York produces many products. If consumption of sugared
sodas is reduced, these companies can switch to their
other products and maintain their workforce and
participate in our efforts to help New Yorkers stay
healthy.
Sometimes state leaders
have to lead. The sugared beverage tax gives you a
chance to do that. We, see the results of high sugar
consumption in our patients across the state. We urge
you to impose the sugared drink tax this year. Passing
the tax this year will send a strong public health
message that our state leaders recognize the role that
soda and sugary drinks play in our childhood obesity
epidemic, and will also to bring desperately needed
revenues into our health care system.
Should there be any
question the AAP also strongly supports increased
taxes on tobacco. Experience has shown that with
each increase in cost, the adolescent use of tobacco
decreases. We would hope to have the same outcomes
with the sugared drink tax.
The APP also supports
additional taxes on alcoholic beverages. We see no
reason for our state leaders to make it more
affordable for people to consume more alcohol than is
healthy. And most people, who do not drink to excess,
will not be adversely impacted. But for young people,
who often indulge in binging, higher costs may reduce
their ability to afford alcoholic beverages.
These initiatives are
not Nanny taxes. Obesity and its co-morbidities of
asthma, liver disease, diabetes, high blood pressure,
heart disease; tobacco with its outcomes of heart
disease, lung cancer, high blood pressure; and abuse
of alcohol with its outcomes substance abuse,
escalation in domestic and stranger violence and car
accidents, cost New Yorkers a great deal. They
increase health care costs for both public and private
insurance and for the state in uncompensated care.
They reduce productivity and the ability to work due
significant chronic illness and injury. They
contribute to increased criminal activity and legal
and correction costs. They also cost individual
families who have sick children, sick parents, or lose
loved ones. There is no rational reason not to make
these particular products that are not good for people
in excess, more expensive to get and to use.
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American
Academy of Pediatrics, District II, New York State
2010 NYS Budget Priorities
To Generate Needed
Revenues AAP Supports:
- Excise tax on
sugared syrup used in sodas and sugary drinks…to
raise needed revenue and reduce consumption on
sugared beverages which contribute to childhood
obesity.
- Increased taxes on
Tobacco to raise needed revenue and to further
reduce smoking and the attendant health risks.
- Increased taxes on
alcohol to raise needed revenue and to impact on
teen binge and underage drinking.
To Maintain Vital
Programs and Services AAP Supports:
- Maintaining Primary
Care Enhancements
- Doctors Across NY
- Creation of a Bright
Futures NY Children's Medical Home Model as part
of the state Medical Home Initiative.
- Simplification and
streamlining of applications for Child Health Plus
& Medicaid
- The state regaining
responsibility for health insurance rate setting
- Physician Gift Ban…with
first offense being a warning, thereafter
financial penalty
- Critical
Restorations of Massive Cuts to:
- Education
- Health Care
- School Based
Health Care
- Home Visiting
Programs
- Child Care
- Juvenile Justice
Community Based Services
- Reach Out &
Read Programs
Early Intervention
Reform Proposals:
- We oppose
implementing Parent Fees. Parent fees have
the potential the limit access to services.
They also may cost more to collect than will be
collected.
- We support requiring
all health insurance policies to pay for evidence
based early intervention services, with no life
time cap.
- We support
increasing pediatric participation in the Early
Intervention Program and creating and supporting a
real Medical Home for these medically fragile
children.
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