LEGISLATIVE UPDATE FROM ALBANY
 
THE DISTRICT CHAIR’S REPORTS TO MEMBERS OF DISTRICT II

Report from the Chair July 2010 (Posted:  7/28/10)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair June 2010 (Posted:  6/20/10)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair April 2010 (Posted:  4/13/10)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair January 2010 (Posted:  1/13/10)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair December 2009 (Posted:  12/21/09)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair November 2009 (Posted:  11/6/09)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair September 2009 (Posted:  9/30/09)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair July 2009 (Posted:  7/7/09)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Brief Budget  Update from the Chair April 2009 (Posted:  4/2/09)

The legislature is in the process of passing budget bills. It is anticipated that a new budget will be in place at the end of the day, or at the latest tomorrow.

We are happy to report that, despite New York State’s significant budget deficit, most of our priorities in children’s health and well being have been funded and some will be seeing additional investments going forward.  The Governor and the legislature saw the wisdom of continued investments in children’s health and well being.

The Children’s Health Insurance program, CHIP, has been expanded to 400% of poverty.  And although there is a small increase in parent payments, they are relegated to the highest income families.

Our recommendations for simplification and streamlining enrollment and renewal in Medicaid and CHIP have been passed as part of the budget.  This will eliminate unneeded barriers to accessing and maintaining coverage.

The investments in primary and preventive care are more than $290 million.  New rate setting, which will drive dollars toward higher payment for primary and preventive care, will take place in the next several months.  It is anticipated that the new system will be up and running by the end of the year.

Work will also go forward in creating standards and payment schedules for Medical Homes. Medical Homes will be implemented at the end of this year.  The District has been active in participating in the development of standards directly related to children’s health care needs.

During this transition period, hospitals will be stabilized with a special transitional fund to help them bridge the payment changes.  Special attention will be paid to those institutions serving the most vulnerable New Yorkers in our highest stressed communities.

Other key issues:

• NO parent fees for Early Intervention Services
• Ability of doctors in hospital clinics to bill directly for their services, enhancing their value to their institutions
• Electronic Health Record revolving loan fund to help practices upgrade to EHR’s (this is state $ in addition to any Federal Stimulus money)
• Physician Registration Fee increase rejected
• Additional $2.5 million for Lead Poisoning Prevention and Treatment, and the creation of a Lead Poisoning Prevention and Treatment Task Force.
• Additional $1 million for obesity prevention
• Child care funding was restored providing families with needed subsidies to care
• Four underused, rural juvenile justice facilities will be closed and 50% of the dollars will be reinvested in community care and transitional services
• Cuts to school aid were restored and all districts will be level funded

We thought you would want to know that as the budget passes, children’s health and well being remained a priority investment for our state leaders.  We will be able to provide additional details within the next week.

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair March 2009 (Posted:  3/27/09)

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair December 2008 (Posted:  12/23/08)

Brief Budget Update
I am pleased to report that despite the significant budget cuts proposed by Governor Paterson in his 2009-2010 State Budget, core children's health programs have been protected.

The SCHIP expansion to children in families up to 400% of poverty remains in place. This initiative will bring New York State as close to universal health care for children as we can be in the current health care services environment.  It is also particularly important to keep SCHIP strong, as more and more families are seeing their employment situations threatened and their employer based health care options diminish.  However, there is also a proposal in the budget to increase parent contributions to the SCHIP program at the upper levels of eligibility.  We will keep our eye on this proposal going forward since all research has indicated that increased cost sharing results in reduced access.

Also on the positive side, the administration proposes to eliminate face to face interview requirements and finger imaging requirements for Medicaid.  These enrollment and renewal simplifications should reduce children losing health coverage and help children and families across the state keep their children and themselves covered.

The work to create the new rate structure called APG's, Ambulatory Patient Groups, is going forward.  The plan is to create a transparent Medicaid rate structure.  The emphasis continues to be to redirect dollars from inpatient to primary care.  The Primary Care Enhancement Initiatives started last year, are all continued in this budget.  For pediatricians the most important components would be the commitment to the implementation of the Medical Home, the support for Doctors Across NY and the continued push of dollars into primary care across all settings.  The Medicaid primary care and office based Fee for Service increases are defined in the Governor's Budget proposal as bringing payments up 80% this year; with additional bump up in the out years.

The state's Medical Home concept is being developed with input from providers, including pediatricians, consumers and insurers.  The Medical Home program will be based on the NCQA three tiered structure.  The Department of Health continues to recognize the necessity of creating a child specific Medical Home based on the Bright Futures model.  Practices who agree to become Medical Homes, that is, those who agree to meet the new, and as yet, unknown standards, will be paid an enhanced rate in both fee for service and managed care programs.  Key representatives of AAP District II will remain active in this ongoing process.  Our goal is to keep the unique needs of children central to the ongoing Medical Home concept development.  The state anticipates being able to have the standards approved by the end of October of 2009 at the earliest.  The Medical Home rate increases are anticipated to be implemented in January 2010.

Rebasing the current DRG's into APG's will see a change in hospital reimbursements.  Dollars are being redirected to primary care.  But it is our understanding that the rebasing will include a reinvestment of $282 million from the straight GME pool into another pool to pay teaching hospitals for the care of the uninsured.  The difference would be that this pool could only be accessed by actual billing for care for the uninsured in the ER's, clinics and in inpatient settings.  These would be countable expenditures as opposed to lump sum payments based on historic usage.  It is suggested by the administration that these dollars would shield teaching hospitals and public hospitals from the harshest impacts of reinventing reimbursements for hospital, clinic and office based care.

The budget also includes:

• Additional $2.5 million for increased work in lead prevention, screening & treatment. This will move up to $5 million next year.
• There is also an additional $1 million for obesity prevention.
• Expansion of Family Health Plus to families earning up to 200% of the poverty level
• Expansion of Family Health Plus eligibility to 19 and 20 year olds

As you probably know there are proposed increases in various fees, taxes and surcharges on numerous products and services.  We are most supportive of the 18% tax increase on sugared sodas and sweetened fruit juices.  This anti-obesity measure is consistent with AAP's position on children’s access to sweetened sodas.  The District has had some good press on the issue and we will continue to work with others toward the adoption of this particular tax.

On the negative side, the budget proposes cuts to education, a re-organization of and parent fees imposed on Early Intervention, reductions in support for Special Education and higher education.  There are also significant cuts to various programs in foster care, juvenile justice services and other services for at-risk children and youth.  But I urge us to remember that this document is the Governor's first proposal.  It is a long way from this proposal to the final State Budget . Our job is to stay vigilant, and speak out in support of issues and programs vital to children’s health and well being as the process unfolds.  We look forward to providing you will specific details of the budget and children’s services to help you target your advocacy going forward.

Happy Holidays!

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair October 2008 (Posted: 11/12/08)

First, I would like to thank all of you for your support in my recent re-election as District Chairperson.  I look forward to serving you with enthusiasm and working with all of you to improve the lives of children and of pediatricians in New York.

At this time, as you know, our state and our nation are in dire financial straits.  There is not much the District can do at the national level other than continuing to support the national AAP. But here in New York, we have much that we can do.

POTENTIAL NYS BUDGET CUTS
Our state is struggling with an enormous state budget deficit.  We should be concerned about the effect of the potential budget cuts on the availability of quality accessible health care to the children of New York.  Right now, no cuts to the CHIP program have been proposed.  But we will certainly know that very deep cuts to child care, education, foster care and juvenile justice services as well as significant cuts to after school programs, community based programs and other supports for families are being proposed.  These cuts should also be of great concern to us because they will directly impact children.

All social-emotional and educational programs for vulnerable children and families are on the chopping block.  The cuts will be severe and deep across the board.  The lives of struggling families will be made much more difficult as they can no longer find safe places for their children while they work.  Our juvenile justice system will have no place to house mentally ill court involved youth and counties will have no resources for detention or prevention services.  What happens in foster care is probably going to be tragic for children, parents and the system itself.

At this time, the Child Health Plus program and the expansion to 400% is still being protected.  But other cuts to health care are inevitable.

It is in this environment that I urge you to become more active in your Chapter and in District II activities as we speak up for children's health and children's well being during these most challenging times.

AAP DISTRICT II INITIATIVES:
Even as we fight for children in hard budget times, we do have several positive initiatives moving forward:

1. The District continues to explore how we can create and support a Parent Advisory Group.
2. We are moving forward with our work to integrate a level of children's mental health and learning services into the primary care setting through the work of the District Children's Mental Health and Learning Work Group.
3. The District continues its work on enhanced primary care payments for pediatricians as the new APG's (Ambulatory Patient Groups) are being developed for Medicaid.
4. The District participated in the development of the Department of Health's new Primary Care Standards.  We know that many of our suggestions were adopted.  We look forward to the publication and implementation of the standards and the enhanced payment that will accompany the implementation process.
5. The Pediatric Councils in each Chapter continue to identify and represent members' concerns with specific health insurance companies.  And, the District is also looking at services that would help support members in various ways in private practice.

VOTE ON NOVEMBER 4th
It does matter to New York State who becomes President.  Right now our state needs federal help.  We need a better federal Medicaid match.  That alone would go far to reduce our current horrific budget and maintain vital services for children.  New York State has the lowest federal Medicaid match in the country.  A few other states are with us in the basement on this, but many other states, especially those in the south, have very generous matches.  Ours is 50/50, some other states are 80/20.

And it does matter who controls our state legislature, most especially in these very confounding budget times.

So, VOTE November 4th…And cast your vote for children. 

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair September 2008 (Posted:  9/12/08)

Welcome back from what I hope was a wonderful summer for all.

If you have been reading the papers, you know that the financial news across the state has not been good.  State government is teetering under what appears to be a $5.4 billion dollar deficit.  County, city and village governments are also struggling with deficits across the board.  Our work to improve the quality of care and access to health care for children and our constant push to increase payment for our services for pediatricians is likely to be increasingly difficult.

CHILD HEALTH PLUS EXPANSION TO 400% OF POVERTY
But we also have some very good news.  During the last Special Session, which cut the existing state budget expenditures by more than $427 million (the Governor wanted $600 million), we were able to maintain the Child Health Plus program expansion to 400% of poverty.  This means that every child in New York will have access to some kind of health care coverage.  In addition to the Child Health Plus expansion, all financial support for outreach and media work to inform families of this expansion has been kept in the budget.  In fact, some of you may have seen print and TV ads letting families know about the new expansion and the availability of coverage for all children.  We encourage you to help spread the word and let all families know that the Child Health Plus program is expanding and that their children, who may not be covered or may not have adequate coverage, can now get Child Health Plus.

Despite this good news, we must remain vigilant because as the Governor and his agencies are putting their budgets together for 2009-10 they are already talking about cuts to all programs.  We will need to continue to advocate forcefully to keep the Child Health Plus program whole and available to all families and children.

RECENT BUDGET CUTS
Unfortunately, many other programs and services that directly impact on children’s health and well being have been severely cut in the most recent budget cuts.  School based health care was cut more than $1 million in the most recent budget cuts.  Reproductive health care services, including services to teens, have also been cut significantly.  Child Abuse forensic services have been cut going forward as dollars for the hospital based Child Abuse Centers have been cut.  There are also ongoing discussions regarding cuts to other programs that we care about.  Stay tuned.  When we know what the Governor and his agencies will be proposing, we will give you the information and guidelines on how we can respond to secure and maintain vital services for children.

LEGISLATIVE UPDATE
On the legislative front, we have not seen anything of major concern.  The Governor did not sign several bills we opposed, but he also did not sign several bills we supported.  In all cases, his vetoes of “good” bills were based on the dollars needed.  Therefore the legislation that would have created regional professional support panels for pediatricians to provide mental health services in their primary care offices was vetoed.

WORKING WITH THE NYSDOH ON IMMUNIZATION ISSUES
We continue to work with the State Department of Health on immunization issues.  The District’s New York Immunization Coalition will be meeting with our partners on September 16th in NYC.  Items on the Agenda include exploring the best ways to counter anti-immunization initiatives and our new work with the autism community to create a better understanding of the health and social and emotional needs of children with autism.  Efforts to increase immunization administration fees, and our work with the Department of Health to the study the feasibility of state universal purchase of vaccines also continues.

CHILDREN’S MENTAL HEALTH AND LEARNING INITIATIVE
In other news, the District is exploring integrating Children’s Mental Health and Learning assessment, diagnosis and treatment into the primary care setting.  It has been decided that each of the three NY Chapters will identify a Children’s Mental Health & Learning Issues champion.  This person will be the liaison between the District’s Task Force and each Chapter’s members.  There are many issues to discuss and currently we have more questions than answers.  But the process has begun.  Our initial thinking is that a specific level of diagnosis and treatment may be possible in the primary care setting if pediatricians have access to needed training and ongoing high level of support.  We are examining using the AAP Bright Futures model as the service structure to build on.

PARENT ADVISORY GROUP
The District is also exploring the feasibility of creating, nurturing and supporting a Parent Advisory Group.  Discussion by the Executive Committee is ongoing.  We will keep you informed as we move forward on this initiative.  If you have an opinion on the District having a Parent Advisory Group, please let us know.  Our current thinking is that we can and should do more to support parents across the state as our partners in the care of their children and all children:  Exactly how to do this remains a challenge.  But with your help we should be able to figure out a way to do this that is good for parents who may be interested in volunteering and good for pediatricians across the state.

As always, we are interested in your input.  This report is not only to let you know what your state leadership is up to, it is to invite you to participate in any way that you can to strengthen our efforts to improve pediatrics for children, parents and pediatricians.  Please contact our District Executive Director, George Dunkel, at gdunkel@aap.org with your comments and suggestions.

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair July 2008 (Posted:  7/10/08)  

     The legislature left Albany the last week of June.  The session is over for now, although there are rumors that the Governor or the leaders will bring the members back for a Special Session shortly after the election.

     Despite the worsening economy and calls from the Governor and our legislative leaders for fiscal restraint, we were able to maintain support in the budget for the significant expansion of the Child Health Plus program to children in families up to 400% of poverty.  It is anticipated that this expansion will bring an additional 400,000 children under the coverage umbrella.  When fully implemented, the expansion will provide as close to universal health insurance for the children of New York as possible.

     The final budget also maintained the shift of dollars from inpatient to outpatient care.  This creates the potential for more dollars for primary care in the office and clinic settings.  As the state moves forward to "rebase" the rates for primary care in Fee for Service Medicaid, it is anticipated that increases will move through the entire system of primary care.  But at this time, there is no real plan to directly increase payments in the Managed Care sector.  Therefore, we continue to encourage you to work with your Chapter’s Pediatric Council to bring your concerns to the insurers in your region.

     We have also secured within the budget a requirement that the state study the advisability of a state universal purchase of vaccine program.  The AAP will most certainly be represented on the study group.  We will keep you informed as this initiative moves forward.  Recent information indicates that the Department of Health has just begun to explore how to proceed with this requirement.

     As the state’s economic condition continues to worsen, it is imperative that we protect the gains we have achieved on behalf of children and pediatricians.  It is possible that the legislature will be called back at anytime to make additional cuts to meet deficit requirements. It is also possible that the Governor will require that his agencies further cut their budgets beyond the 2.5% cut he has already required.  Our job, as always, will be to protect vital investments in children’s programs.

     Legislatively, the session was most active.  We had some successes and some disappointments.  The session was difficult and many issues that are often resolved in the last few days were not attended to due to the resignation of the long time leader of the Senate, Senator Bruno.  The Expedited Partner bill we supported did pass.  Our Flu in the Neonatal Unit came very, very close.  It passed the Assembly and was reported out of the Health Committee in the Senate.  It was reported out of Rules and was ready for a vote on the floor, when Senator Bruno announced his resignation and all business stopped.  We played a significant advocacy role with many other organizations in the Healthy Teens Act and the Healthy Schools Act.  Although neither passed, both will be back next year for another effort.

     We also worked very hard to stop several very strong anti-immunization bills.  We defeated every one, but it took significant effort and time to assure that they didn’t move forward.  These will also be back next year.

     So, as you can see, your District is very active in advocacy and policy issues for pediatricians and for children.

     As we move through the more relaxed days of summer and through the fall to the elections in November, please keep in mind that every state legislator is up for election.  We encourage you to challenge your local Senatorial and Assembly candidates to support the priorities of the AAP for pediatricians and for children.

Have a great summer!

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair May 2008 (Posted:  5/6/08)  

     I am very happy to report to you that this year’s final state budget has some very good investments in children’s health and well-being.  As detailed in my earlier reports the final state budget supports a significant expansion of Child Health Plus to families earning up to 400% of the poverty level, which is $82,000 for a family of four; a redirection of dollars in the Medicaid fee for service system from hospital based care to primary and preventive care; additional dollars to prevent, diagnose and treat lead poisoning; resources to better serve children with chronic diseases through disease management approaches; new options to fund social workers in school based clinics, expansion of Medicaid coverage to young people aging out of foster care up to age 21; and investments in early child care and pre-K as well as a significant increase in education funding.

     However, I know that there are already pressures being applied to the budget to reduce the spending that has been approved.  And so, there is a possibility that some of those programs and service enhancements which we have won will become part of an as yet to be detailed budget cutting process.  At this time, the latest information we can glean indicates that there are no current plans to reduce funding in any area of children’s services outlined in our priority areas.  But it is still early in the budget-cutting discussion.  The Governor has called for a 3.35% cut across the board from all agencies.  Our hope, as we work with the various Departments responsible for children’s health and well being, the Division of the Budget, the Governor’s Office, and the legislature, is to maintain support for key children’s health and welfare investments in the final budget.  We will keep you informed as the process moves forward.

     The budget may be completed, but the legislature is in session until the third week of June.  During this period many bills will be proposed, debated, go through committees, get to the floor of the Assembly and/or the Senate, and get to the Governor’s desk for signature.  Many other bills will languish, never getting out of committee, or never making it to the floor of either house for a vote, or only making progress in one house.  The District will be asked for its position on almost all legislation that impacts on children’s health and well being, from anti-tobacco legislation to lead poisoning, to access to health care, nutritional issues, childhood obesity, and everything else, including services for autism, diabetes and children’s mental health.  We will produce Memos of Support if we support the bill or Memos of Opposition if we oppose the bill.  In each case our Memos will outline the reason we support or oppose the legislation.  The District also has its own legislative agenda.  Our key bills this year include passage of enhanced lead poisoning legislation (A6399C/S6350), passage of a bill that would require all hospitals with neonatal units to offer parents and other care givers flu shots on site (A5475/S4601), Breast Feeding Bill of Rights, (S1674/A3782) and an Expedited Partners Therapy bill, (A8730/S6210).  As the legislative session moves forward, we will be asking for your help to move these bills forward.  At the same time, we will be working hard to protect the budget investments in children’s health during ongoing efforts to reduce state expenditures.

     With your help and support, we should be able to maintain the expansions in children’s health care and celebrate passage of legislation that can further improve and strengthen our efforts to keep all children healthy.

     We will report back on all our efforts as the session moves into high gear in May and moves toward closure in late June.

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair February 2008 (Posted:  3/3/08)

     I am pleased to report that on February 26th the District had its most successful Advocacy Day yet!

     More than 60 physicians, members of AAP and APA, came to Albany to talk with state leaders in children’s health and with their own state legislators about key issues for children and for pediatricians. 

     The Deputy Secretary for Health and Human Services, Chair of the Assembly Health Committee, Chair of the Senate Health Committee, State Department of Health Deputy Commissioner for Public Health Programs, and the Deputy Commissioner for Health in the State Insurance Department all came to talk with us about children’s health issues in New York State. All speakers also took questions from the group and offered to work with us to resolve some of the specific but broad based issues that were described by members. Each speaker expressed support for our key budget and program issues and promised to work with us going forward through the legislative session to get the best possible outcomes for children.

     For those of you who were not able to join us, we encourage you to meet with your legislators at home. Every Senator and Assemblymember has at least one home District Office, and some have several, depending on the size of the District and their seniority. If you don’t know who your legislators are, feel free to contact us at 518-456-0951 or gdunkel@aap.org and we will help you find the contact information you need.

     You can view our Children’s Budget Issues Sheet and our Legislative Sheet by accessing the links below. (The Budget Issues Sheet is also included in the body of this document.) Feel free to print it out and share it with your legislators. If you cannot schedule a personal meeting, you can print out the sheet(s), handwrite a personal note asking for her/his support, include your contact information, (a card is good), and mail it.

     It was obvious from our work in Albany this week, that we have a real chance to get really good things done for children and for pediatricians if we all work together and become politically active.

     I urge you to print out the sheets and take action now!!

• Children’s Budget Issues Sheet – AAP, District II: http://www.aapdistrictii.org/pdf/Advocacy_Day_Support2.doc
• Legislative Sheet – AAP, District II: http://www.aapdistrictii.org/pdf/Advocacy_Day_Support.doc 

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State

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Report from the Chair January 2008 (Posted:  1/17/08)

     This is a very busy time for your District.  Because of the many issues that have surfaced both externally from government and community and internally from within the membership, I will give you a rundown of what we have been up to on your behalf.

     On February 26^th the District will hold its Annual State Advocacy Day in Albany.  The program starts at 9:00am.  Presenters include:  Dennis Whelan, Deputy Secretary Health and Human Services, Richard Gottfried, Chair Assembly Health Committee, Kemp Hannon, Chair Senate Health Committee, Gus Birkhead, MD, Deputy Commissioner for the Office of Public Health.  If you want to participate in strengthening pediatrics and supporting pediatricians in New York State, please join us as we advocate for our patients and for ourselves.

2008 Issues and Activities  

• The District continues to advocate for increased payment for pediatricians.  We are proposing a Bright Futures model of service to drive higher payment for an enhanced preventive and primary care model.  Governor Spitzer’s State of the State speech included proposals for increased  budget investment in primary and preventive care.  We are working to assure that  this proposed increase comes to all pediatricians.
• The District has an ongoing relationship with the State Department of Health as the Statewide Immunization Registry is implemented.  We are pushing to bring pediatric concerns forward and to make sure the Department understands the implications of some of its expectations, particularly the fiscal implications.
• The District will be holding its annual Campaign for Healthy Children meeting on February 20^th in NYC.  Our major partners in the Campaign include the infant and child care community, the children’s mental health services community, child advocates, child welfare, foster care and juvenile justice organizations, community health providers and public health groups to name a few.  Together this group amplifies the voices of pediatricians in the state budget and program development processes.
• A discussion is taking place among the Executive Committee members on the state  proposal for a Physicians Rating process.  The District is in the process of developing a position that will reflect the special needs and the special circumstances of pediatricians and identify specifics of quality measures in pediatric practice.
• The District will be holding its second Statewide Immunization Coalition Meeting March 20^th.  This group brings the District together with other groups with an interest in and commitment to universal immunization.  Key partners in this group include the teachers’ union (NYSUT/NEA), School Boards Association, State PTA/PTO, State Child Care Coordinating Council, Visiting Nurses Association, and the NYCDOHMH’s Bureau of Immunization.  The State Dept of Health also plays a significant role in the Coalition.  The District has identified a corps of pediatricians, a minimum of three from each Chapter, who have volunteered to be local team leaders when and if immunization advocacy is required.  These pediatricians will also be reaching out to their local counterparts from our partner organizations to form local immunization teams.
• The District is working on the long term implementation of its major paper, Building Blocks for a Medical Home for Every Child.  This document describes the District’s position on how to structure the best possible health coverage for children, and how to pay pediatricians equitably for the high quality care they provide.  It has been widely circulated to state decision makers and is available on our website.
• Advocacy work for the District on special issues include: leadership on the School Nutrition Bill, work on programs to address childhood obesity, asthma and diabetes, Expedited Partner Therapy for STD’s,  building capacity and access in children’s mental health services and other issues that will be brought forward by the membership during the 2008 legislative session.

     I encourage you to become active in your Chapter and in the District as we work together to strengthen pediatrics for children and for pediatricians.  

Henry Schaeffer, MD, FAAP, Chair  

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Henry,

Relative to our discussions on the Immunization Registry, now that we are able to talk about the proposed State budget I wanted to highlight several items that speak to the reimbursement issue:

1. Medicaid will be increasing physician fees significantly from 32% to 75% of the Medicare level over two years starting January 1, 2009.  When fully implemented: - Office based physicians will see a 64% increase ($55.8 million) - (Clinic based physicians rates will rise similarly)
2. Medicaid will give a 10% bonus fees for office-based physicians who furnish medical care services in Health Profession Shortage Areas.
3. Child Health Plus will increase eligibility from 250% to 400% of poverty effective July 1 using 100% state funds. This should reduce the number of kids with no health insurance in increase physician practices' ability to get reimbursed for vaccine administration as well as access VFC vaccine. This year, approximately $37 million more funding will provided to insure eligible kids.
4. The budget calls for the health department to conduct a study of the feasibility of developing a universal purchase/distribution vaccine system, which would remove vaccine purchase as a major cash flow issue for many practices.
   
   Not directly related to immunizations, but might benefit larger practices:
   
5.  Medicaid will provide reimbursement for certified diabetes educators to provide diabetes self managment training. Also, Medicaid will provide enhanced reimbursement for physicians who are recognized through the Diabetes Physician Recognition Program (NCQA) and the Bridges to Excellence Program. Total funding when fully implemented, $7.2 million.
6. Medicaid will provide reimbursement for certified asthma educators.
   
   Also, benefiting physicians in underserved areas
   
7. $150,000 loan repayment over 5 years
8. $50,000 for each of two years to set up practice

All told, there is at least $100 million in new funding.  So there is some good news on this front.

Gus

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November 2007
(Posted:  11/1/07)

I am pleased to report that your District has been very busy over the last several months.

Our major areas of focus during this period were:  
  *  Working to Implement Universal Health Care for the Children of New York State
  *  Working to Improve Immunization Processes & Procedures for Pediatricians and Families

1.  CHILDREN’S UNIVERSAL HEALTH CARE

I presented testimony on behalf of the District in New York City before the Governor’s Statewide Hearings on Universal Health Care, Partnership for Coverage on October 30th.  Key issues included a child focused benefit package, the importance of paying adequately for high quality primary care, building pediatric capacity in primary and subspecialty care to ensure equitable access to care as we move toward universal care and assuring a Medical Home for every child.  I was asked if pediatricians are ready to step up to the plate and provide universal access to high quality care.  I responded that yes we were, if we were paid fairly for that care.  You can access my testimony by the clicking http://www.aapdistrictii.org/advocacy/Testimony_10_30_07.doc, which will take you to the District website.
  
Elie Ward, the District’s Director of Policy & Advocacy, presented testimony before Assembly Health Committee Chair, Richard Gottfried’s Hearing on Primary Care, also in late October.  Her remarks were well received and we were asked if we could design and present an enhanced children’s primary care model to the Assemblyman and his committee for review.  A small committee has been assembled to tackle this request.  Ms. Ward’s testimony is available at http://www.aapdistrictii.org/advocacy/TestimonyWard.doc. 

We are continuing to have meetings with key administration staff to move our recommendations as presented in the District’s document, “Building Blocks for a Medical Home for Every Child,” from proposal to reality for the children in our state.  A copy of “Building Blocks” is available on the website, http://www.aapdistrictii.org/NYSHealthCare.pdf. 

The District is working hard to help the state of New York do the right thing for our children as the Congress and the President continue to struggle over the expansion and funding of the SCHIP program.  Our goals are:  to help the state move forward on our proposals for children’s health simplification and expansion;   to increase payment to pediatricians for caring for children, there is a budget line in the Governor’s early proposed budget increasing payment for primary care, but the details are not yet available; and to continue to work to maximize pediatric input into all health and health care decisions related to the care of children.

2. IMMUNIZATION

The District has also been playing central role in working with the State Department of Health on all aspects of childhood immunizations.

We presented a very well received Immunization Summit at Mohonk Mountain House the first weekend in November.  Response from those attending was very positive.

The District has also recruited Chapter Champions for the District’s Statewide Immunization Coalition.  The work of the Coalition will be to help educate the public on the value of childhood immunizations.  The Coalition will also be available to help communities who find themselves under attack by anti-immunization forces.  Our key partners in the Coalition are: NYSUT, the New York State United Teachers, representing more than 500,000 teachers statewide, the NYSNA, the New York State Nurses Association, the group representing most of the state’s nurses, the NYSPTA, New York State Parent Teachers Association, representing parent groups in more than 700 school districts, and the NYSCCC, the New York State Child Care Coordinating Council, representing most of the licensed and registered child care providers across the state.  Other groups are part of the coalition, but are not members of the steering committee.

The District staff has taken an active role in working with SDOH to develop plans to implement the Statewide Immunization Registry.  Operationalizing the Statewide Registry only has implications for pediatricians outside of the five boroughs of New York City.  New York City practices will continue to work with their City Immunization Registry.

Our efforts on the Statewide Registry have resulted in the state deciding that during Year One all efforts will be made to train practices to work with the registry and support them in their efforts.  Any pediatrician who makes a good faith effort to participate in the registry to the best of his or her abilities will not face any sanctions.  A schedule of regional trainings, and the State’s letter outlining how practices can best begin their participation is available at http://www.aapdistrictii.org/immunizations/NYSIIS_FAQs.pdf and http://www.aapdistrictii.org/immunizations/NYSIIS_Letter.pdf.  The Department is more interested in getting full pediatrician participation than in imposing any penalties.   We encourage all members who do not have an HPN to apply for one as soon as they can.  Information on the District website will help walk you through this process.  You should also be getting a letter from the Department if you practice outside of New York City.

For New York City practices, the District has begun to work more closely with the City’s Bureau of Immunization.  We are partnering on developing a process to help resolve immunization payment issues.

The District has also learned that the administration is still discussing State Universal Purchase of Vaccines as a budget issue.  We will keep you informed as more details emerge.  The District will remain vigilant to assure that pediatric interests remain part of any plan to move toward universal purchase.

3.  ADVOCACY

As the District continues to work on your behalf on many fronts, it is imperative that you, our members, take an active role in the work that we do.  Your recent activities to push Congress on the SCHIP program had impact.  We were able to move four out of six New York State Republican members of Congress to vote with us on the issue.

At the state level we will need your help once the budget negotiations get started and once legislation gets introduced.   The legislature comes back into session shortly after the New Year and the state budget is presented by the end of January.

The District is planning a NEW YORK STATE ADVOCACY DAY FOR FEBRUARY 26 IN ALBANY.  This is a time when you can meet with your colleagues from across the state and talk with state leaders and legislators about our priorities.  I urge you to join us and strengthen the pediatric voice for children’s health in New York State. 

If you have questions, concerns or need more information about any issues presented in this report do not hesitate to contact me directly.

Henry Schaeffer, MD, FAAP
Chair, AAP District II, New York State 

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August Letter
(Posted:  8/1/07)

JUST A LITTLE “LITE” READING TO TAKE YOU THROUGH AUGUST 

The District has been busy positioning itself to move its key children’s health policy and program issues forward. Our efforts at this time are focused on our children’s universal health care proposal, “Building Blocks for a “Medical Home” for Every Child, which you all received in the last e-mail and our Campaign for Healthy Children’s Agenda, which is available on the District's website at http://www.aapdistrictii.org/.

The District is working with key administrative staff to secure enhanced payments for children’s preventive and primary care visits, for pediatricians “managing care,” and for immunization administration as part of the state’s design of universal health care for children. Staff of the District and staff within the administration are also exploring universal purchase of vaccines for distribution to all pediatric practices, enhanced mental health services for children in the primary care setting and building additional capacity for children’s oral health services.  The District staff and leadership are also working with key administrative staff and key partners in the private, not for profit sector who are decision makers in the areas of health and children’s health to achieve our goals. 

The District is hopeful that many of its priority issues will be included in the Governor’s 2008 State Budget Proposal and in majority party legislative proposals. This approach would put our members in the position of working in support of agenda items that are already included in the state’s plan instead of having to fight to get children’s health insurance initiatives considered as part of the larger health reform plan.

During the last few months the District has had several key meetings.  Two very positive meetings were held with the Governor’s senior staff responsible for children’s health programs.  District leaders also had a very positive meeting with James R. Tallon, Jr. President of the United Hospital Fund. Follow-up will include meetings with key state budget staff and meetings with both children’s health and children’s health insurance staff within the administration and those working in key not-for-profit organizations.

Our goal is to get as much of our agenda into the Governor’s Program Bill and Budget Bills as possible  Should we be successful, this would create a pro-active stance for our advocacy.  Whatever we cannot get into the Governor’s initiatives, we will work with the legislature to bring forward.

This is a year of opportunity for pediatricians and for children.  The District will keep you informed as we move forward, and will call upon you to help when the time is right.

Have a great end of Summer...

Respectfully submitted,

Henry Schaeffer, MD, FAAP
Chair

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March Letter
(Posted:  3/12/07)

American Academy of Pediatrics, District IIMy last report described the new opportunities in children’s health policy and program that have been made possible by changes in the New York State Governor’s Office and in Congress.  This month I would like to bring you up to date on what we have been doing to take advantage of the new environment to improve health care for children, and improve the practice of pediatrics for our members.


UNIVERSAL HEALTH CARE WHITE PAPERS ARE ALMOST COMPLETE

The District is almost finished with its Task Force white papers on how to implement Universal Health Care for the children of New York.  Papers have been completed by members of the Streamlining/Systems Task Force and by members on the Benefits Task Force.  The Financing Paper is in its final stages.  These three documents present the District’s positions on key issues in children’s health care and coverage.  Once they are approved by the Executive Committee, they will be formally shared with key decision makers in the state administration and the legislature and will be made available to District members.  Currently, the content of these documents is the basis of many of our conversations with senior administration officials and key legislative leaders.


STATE IMMUNIZATION COALITION

The District held the first meeting of its newly created State Immunization Coalition.  Participants included leadership from NYSUT/NEA, representing more than 500,000 teachers and other educators across the state; State PTA, representing parents in the more than 700 school districts across the state; New York School Boards Association, representing school board members; NYSNA for the nurses; Health Plan Association, representing most of the Managed Care plans; the New York State Child Care Coordinating Council, representing child care providers statewide; MSSNY, representing the rest of medicine and, of course, us.  The meeting was very productive.  All participant organizations agreed to work together to create pro-immunization public education messages and materials.  All participants also agreed to work together to develop local teams to carry our messages and materials to local communities.  The groups, who have really never worked together before, were enthusiastic about coming together around the immunization issue. 

We are currently working with the graphic department at NYSUT/NEA to design a logo for the group.  Two goals agreed upon during the first meeting were: 1) producing a brochure or booklet about the importance and the safety of timely childhood immunizations that all organizations can use and distribute; and 2) finding opportunities for members to talk with their groups about immunization at statewide and community meetings.  We will keep you informed as the group solidifies its identity and formalizes its activities.  We are hoping for a Press Conference to announce the group and its work sometime after the state budget passes.


2007 CAMPAIGN FOR HEALTHY CHILDREN AGENDA

The AAP’s Campaign for Healthy Children’s (CHC) Agenda 2007 has been released.  The document defines the District’s priorities for children’s health and well being.  It is the product of a longstanding partnership with more than 40 community based organizations.  The Agenda details our positions on a broad spectrum of children’s health issues from immunizations, to mental health services for children, to environmental health, to oral health.  The CHC Agenda has been distributed to every legislator and to many key staff members in the Governor’s Office and the Department of Health.  It forms the basis for our advocacy during the year.  You can access a copy of the agenda on our District website at http://www.aapdistrictii.org/CHC2007-08.pdf.


LEGISLATIVE ADVOCACY DAY – 3/21/07

The District’s Legislative Advocacy Day will be held on March 21st in Albany.  I encourage you to attend if you can.  We will have presentations from Dennis Whelan, the Governor’s Secretary for Health and Human Services, the Honorable Richard Gottfried, Chair of the Assembly Health Committee, and the Honorable Kemp Hannon, Chair of the Senate Health Committee.  Several other legislators may also stop by and there will be ample time for questions.  After the presentations, we will have a discussion about how each member can best represent the needs of children and pediatricians, and how to use our advocacy materials.  We will provide lunch, after which members will meet with their legislators to discuss our key issues and concerns.  For more information, please visit the District’s website at www.aapdistrictii.org.


It is my hope that these e-mail updates help members stay connected to the work of the District.  We are very involved with both public and private partners to make the lives of children and the lives of pediatricians better.  Our expanded activism calls for expanded participation from our members.  Please work through your Chapter or the District staff to find the best way to become more involved in the work of the District and its Chapters.  Perhaps you can become a member of one of the local Immunization Public Education Teams we will be putting together in communities across the state.  Or perhaps you can visit your state legislator in his or her local office and share our materials and priorities.  We all need to work together over the next several years to assure that we have made maximum effort during a time of great possibilities for children’s health.


Respectfully submitted,

Henry Schaeffer, MD, FAAP
Chair
American Academy of Pediatrics, District II

New York Budget to Reform New York Health-care Industry.
(Posted:  4/5/07)

Legislatative Update

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The agreement reflects a significant reduction in the overall rate of growth in Medicaid spending from 8% to 1%.  Governor Spitzer's proposal to provide health insurance coverage to the 400,000 uninsured children by increasing eligibility requirements for Child Health Plus from 250% to 400% of the federal poverty level is included in the agreement.  Also included were the Governor's proposals to provide greater Medicaid funding for facilities that serve a higher percentage of Medicaid patients and to eliminate phantom GME payments.

The budget package restored close to fifty percent of the proposed reduction in funding for hospitals and nursing homes.  Additionally, a proposed freeze on HMO payments for the Managed Care Program, the Family Health Plus Program and the Child Health Plus Program was included as part of the budget.

Other issues of importance to physicians also have been resolved including:

• An appropriation of $130M to fund the Excess Medical Liability Program.  In addition, the language to extend the excess program as well as the Superintendent's authority to set medical liability premium rates through June 30, 2008, was included in the budget;
• The "physician prevails" language under the Preferred Drug Program was maintained. Moreover, anti-depressant drugs will continue to be exempt from inclusion on the list of preferred drugs in the preferred drug program. Additionally, cost cannot be used as a factor to restrict drug access under the state's Clinical Drug Review program;
• An allocation of $1M for additional reimbursement to physicians who provide home medical care;
• An appropriation of $100,000 for MSSNY's "Get Tested, Get Treated" HIV educational program; and
• A re-appropriation of the $6M which had been approved in the previous two state budgets for MSSNY's Health Information Technology for Physicians Program.

• a New York Wellness Works Program whereby grants will be made available to enable employers to develop and implement health promotion and disease prevention initiatives;
• a pilot program to identify zip codes with high concentration of elevated blood lead levels for the Department of Health to work with local health officials to develop a primary prevention plan to prevent exposure to lead-based paint;
• creation of an Empire State Stem Cell Board for the purpose of administrating the state stem cell trust fund including the establishment of criteria for awarding research grants;
• a requirement for school health certificates to state a student's body mass index (BMI) and weight category.