NEW YORK, NY (Oct 18, 2007) – In an expanding industry-wide investigation, New York Attorney General Andrew M. Cuomo today issued letters to Empire Blue Cross Blue Shield, Preferred Care, and HIP Health Plan of New York/GHI requesting information on the insurers’ doctor ranking programs. The Attorney General also alerted New Yorkers about potentially deceptive programs driven by financial motives and not consumers’ best interests.

“Consumers need to be aware that doctor ranking programs as currently designed may steer patients to the cheapest, but not necessarily the best doctors, letting profits trump quality,” said Attorney General Andrew Cuomo. “Transparency and accurate information are critical when making health care decisions and should not be clouded by conflicts of interest.”

In the three separate letters sent today, Attorney General Cuomo:

• Requested New York City-based Empire Blue Cross Blue Shield to justify its existing ranking program known as Blue Precision, currently offered to national employers in New York City.
• Directed Rochester-based Preferred Care to halt the launch of its planned doctor ranking program and to provide details about the system.
• Warned New York City-based HIP Health Plan/GHI to refrain from launching such programs without the prior consent of the Attorney General.

In the letter to Empire Blue Cross Blue Shield, serving approximately 533,271 members across New York State, Cuomo also questioned Blue Precision’s strategy to steer consumers to preferred doctors. In a publicly available presentation outlining the program, Empire describes its “sanction” model which pressures consumers to switch doctors by imposing financial penalties.

Blue Precision is expected to be operating in 22 states by 2008. The program is already available to national employers such as Wal-Mart, which has deployed the program in Florida.

“When making healthcare decisions, it is vital consumers have as much honest information and unfiltered advice as possible,” said Cuomo. “Ranking systems are in their infancy. Consumers should use caution and have an open dialogue with their doctors.”

In the letter to Preferred Care, serving approximately185,188 members across New York State, Cuomo also cited concern about the insurers’ "report cards," which include a measure of patient satisfaction based in large part on cost criteria.

Attorney General Cuomo is scrutinizing the emerging national trend of physician ranking programs in an effort to ensure consumers are protected. Similar letters have been sent to UnitedHealthcare, Aetna Health Plan, and Cigna in recent weeks, and discussions with these companies are ongoing.
For a complete list of county-based enrollment data, visit:
http://www.health.state.ny.us/health_care/managed_care/report/2005/2005complete.pdf
Copies of the letters are available at www.oag.state.ny.us.

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"The New York Parent Education and Awareness Program
How the Court System is Succeeding in Protecting Children Whose Parents are Going Through Divorce, Separation or Other Child-Centered Litigation" 

New York State’s Chief Judge, Judith S. Kaye, announced in her 2001 State of the Judiciary Address an initiative to institutionalize parent education for separating and divorcing parents.  A 19-member advisory board was created to oversee this process. The Advisory Board is comprised of individuals from across New York State and includes representatives in the fields of pediatrics, child psychiatry and psychology, social work, and family life science, as well as a matrimonial attorney and law guardian, and Family Court, Supreme Court and Appellate Division judges.

What is the New York State Parent Education and Awareness Program?  It is a program designed to educate divorcing or separating parents about the impact of their breakup on their children. The primary goal is to teach parents ways they can reduce the stress of family changes and protect their children from the negative effects of ongoing parental conflict in order to foster and promote their children’s healthy adjustment and development.

Why have this program? You do not have to know someone who is undergoing a separation, divorce or other child-centered litigation, you do not have to experience it yourself, nor do you have to view the recent film, "Squid and the Whale" to recognize that putting children in the middle of the adult conflict can be detrimental to their health and well-being.

Studies have long documented an increased risk of adverse outcomes for children subject to their parents’ conflict including poor psychological adjustment, more behavioral problems, higher utilization of mental health services as adults, higher rates of disruption in their own marriages, to name but a few.  However many parents have not been educated about these issues, and some, despite their awareness, cannot change their behavior because they do not have the tools to do so.  Experience has shown that if parents are educated to understand the psychological and legal process they are undergoing, the outcomes are more positive for all involved.

How does this type of behavior play out in the matrimonial and family court case’s judges preside over throughout the State?  The Hon. Evelyn Frazee, Chair of the New York State Parent Education and Awareness Program’s Advisory Board tells a story from her own experience.

"I have seen too many children adversely affected by their parents’ conflict from the extreme of a case in which a 12-year-old boy tried to commit suicide because he felt inextricably trapped in his parents’ war with each other to the commonly seen symptoms of depression or withdrawal, decline in school performance, somatic symptoms such as headaches and stomachaches, involvement in unhealthy activities (acting out) such as drinking, drugs and promiscuous sexual activity.  And then, of course, there are my adult friends who have had and continue to have what should be happy life events for them-graduations, weddings, birth of a child, holidays-marred or turned into stressful events because their parents are still at war and cannot focus on their child’s needs or interests."

How do I learn more about the Parent Education and Awareness Program? Following the guidelines developed by the Advisory Board, the Office of Court Administration certifies and monitors local providers of such services who wish to accept court-referred participants. The New York State Parent Education and Awareness Program has a website at www.nycourts.gov/ip/parent.  It contains the guidelines and procedures for certification and the forms required for providers.  A list of certified parent education providers can also be found on the website. There are currently 48 certified parent education providers in 38 counties offering classes in 58 locations.  There are guidelines for courts to provide assistance in referring parents to parent education programs.  Trainings, which are available on video, have been conducted with parent education providers and judges.

Conclusion

This is just a brief overview of the current status of the New York State Parent Education and Awareness Program. Experience and research have shown that parent education does make a positive difference for children and their parents who are experiencing divorce or separation and it can help bring about a reduced need for court intervention. In addition to judges making referrals, individuals can self-refer to these programs, and attorneys can refer their clients to them. Currently, parent education is available in 38 counties. We are working to make parent education available in the remaining 24 counties in New York State.  If your county or area does not have a parent education program and you have some suggestions as to potential providers, you can contact the Program by e-mail at nyparent-ed@courts.state.ny.us or at the toll-free number at 888-809-2798, or by mail at the Parent Education Board, 140 Grand Street, Suite 701, White Plains, New York 10601. Also, you can locate information about parent education at the parent education website at www.nycourts.gov/ip/parent-ed.  Please "get the word out" about this valuable resource.

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Questions and Answers for Practitioners
Regarding the New Official Prescription Program

• Q.        What new law has recently been passed that affects how practitioners write prescriptions for their patients?
  A.        A new Section 21 of the Public Health Law requires that by April 19, 2006, 
  all prescriptions (both for controlled substances and non-controlled substances) written in New York State be issued on an official New York State prescription form, the same form that was previously required for prescribing Schedule II and Benzodiazepine controlled substances.
   

• Q.        What is the purpose of the new law?
  A.        The new law will combat the growing problem of prescription fraud.  Official prescriptions contain security features specifically designed to prevent alterations and forgeries that divert drugs for sale on the black market.  Some of these contaminated drugs end up in patients’ medicine cabinets.  By preventing fraudulent claims, the law will also save New York’s Medicaid program and private insurers many millions of dollars every year.
   

• Q.        Does the law change the way practitioners issue prescriptions?
  A.        It is important to note that the law makes no changes in the way practitioners issue prescriptions.  Practitioners will still prescribe for their patients in the same manner.  Only the prescription form itself will change.
   

• Q.        Does the law change the way patients get their prescriptions filled?
  A.        No.  Pharmacies will still fill prescriptions and maintain prescription records for patients as they always have.
   

• Q.        When does the new law go into effect?
  A.        It is important to note that an official prescription continues to be required for prescribing schedule II and benzodiazepine controlled substances.  To give the medical community adequate time to convert to the new forms, there will be an 18 month transition period in which both an official prescription or a practitioner’s current prescription blank may be used to prescribe all other medications.  After April 19, 2006, all written prescriptions must be issued on the Official Prescription form. 
   

• Q.        How will practitioners obtain their official prescriptions for prescribing?
  A.        A practitioner must first register with the Department of Health. The Department will provide official prescriptions to registered practitioners free of charge.  Practitioners will be issued individualized official prescriptions preprinted with their practice information.  In the near future, the forms will also be issued to group practices and to hospitals, nursing homes, and other healthcare facilities for use by staff practitioners.
   

• Q.        What procedure must practitioners follow to register to receive their official prescriptions?
  A.        In phases, all practitioners will be mailed informational materials and an application for registration, which also will be issued without fee.  You are urged to complete and submit the application promptly.  Once registered, you will be given specific details on how to easily order official prescriptions by mail, telephone, or internet.  They will be mailed to an appropriate address listed on your registration.  By April 19, 2006, all practitioners must be registered to receive official prescriptions.
   

• Q.        Are practitioners who currently purchase official prescriptions by mail for prescribing schedule II and benzodiazepine controlled substances also required to register?
  A.        Yes.  These practitioners will be the first to be sent applications for registration. Once these practitioners have registered, they will be provided their prescriptions free of charge.
   

• Q.        What is the best way for registered practitioners to order official prescriptions?
  A.        The Department is in the process of developing a secure internet website for this purpose.  It will be the fastest and easiest way to order Official Prescriptions.  Once the site has been developed you will be mailed a password to access the site and place your order.  Registered practitioners who order by internet will receive free official prescriptions in quantities adequate for all prescribing.  Practitioners who order by mail or telephone will receive only limited amounts of prescriptions, which during the transition period must be conserved for prescribing schedule II and benzodiazepine controlled substances.
   

• Q.        How must official prescriptions be secured?
  A.            Practitioners should safeguard their official prescriptions against loss, theft, or unauthorized use.  It is important to note that official prescriptions issued to group practices or multiple offices are not required to be stored in a central location. Practitioners may store and use the prescriptions issued to them at any location where they practice.
   

• Q.        Are practitioners licensed in other states required to prescribe on an official prescription for their patients living in New York?
  A.        No.  Out-of-state practitioners may prescribe on their own personal prescription blank.  If the prescriptions contain all information required by law, New York pharmacies will be allowed to fill them in the same manner as official prescriptions.
   

• Q.        Is electronic prescribing still allowed under the new law?
  A.        Yes.  A practitioner may still transmit a prescription for a non-controlled medication to a pharmacy by secure electronic means.  The new law encourages practitioners to convert to electronic prescribing, which reduces medication errors and does not require the use of an official prescription.  For medical practices that utilize an electronic medical records system to generate prescriptions in their offices, the Department has future plans to provide official prescriptions forms designed for computer printers.
   

• Q.        Will the Department of Health collect data from official prescriptions?
  A.        The new law requires pharmacies to submit data only from prescriptions dispensed for all controlled substances.  The Department will monitor this data to protect practitioners from drug seekers.
   

• Q.        How will the monitoring of official prescription data protect practitioners from drug seekers?
  A.        The new law allows the Department to notify practitioners when analyses of official prescription data indicate that their patients are obtaining controlled substances from multiple sources, an illegal and dangerous activity known as ‘doctor shopping’.  ‘Doctor Shopper’ programs in other states enjoy overwhelming support from their medical communities and have reduced this drug-seeking activity by as much as 65%.  The Department is in the process of establishing this new program.
   

• Q.        Whom can practitioners contact with questions about the new law and official prescriptions?
  A.        A Help Desk is readily available at 1-866-811-7957 to answer your questions and provide information about how to register and order your official prescriptions.
  
  

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New York State Early Hearing Detection and Intervention (EHDI) on the AAP web site.

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Dietary Substances Containing Ephedra Banned from Sale in New York State

The Legislature’s passage of Assembly Bill 6921C/Senate Bill 3294B, sponsored by Assemblywoman Audrey Pheffer and Senator Charles Fuschillo, would ban the sale of dietary supplements containing ephedra in New York State. Governor George Pataki is expected to sign this measure. This issue has received increased attention by the Legislature this year as over 100 deaths have been attributed to the use of ephedra in dietary supplements. The Medical Society of the State of New York supported this measure and participated recently in a press conference Senate Majority Leader Bruno and Sen. Fuschillo. In May, the Medical Society also participated in a roundtable held by members of the Assembly. Over 3,000 Adverse Events Reports (AERs) have been reported to the Food and Drug Administration regarding ephedra based supplements. Since ephedra is classified as a dietary supplement instead of a drug, it has been difficult for the FDA to regulate the substance despite the reports of serious side effects including seizures, heart attacks and brain hemorrhage.

Legislation Establishing Childhood Obesity Prevention Program Passes

Legislation, which would establish a childhood obesity prevention program within the Department of Health, passed the New York State Legislature this week (June 16-21). The measure, Assembly Bill 2800A/Senate Bill 2045A, sponsored by Assemblymember Felix Ortiz and Senator Mary Lou Rath, directs the Department of Health to establish a prevention program within the department with an emphasis on preventing and reducing the incidence and prevalence of obesity in New York State’s children and adolescents. Under this measure, the Department of Health would be responsible for developing media campaigns, sponsoring periodic conferences/meeting to discuss nutrition and exercise and helping communities to develop programs that involve caregivers and parents. The bill now goes to the Governor for his signature.

The multibillion-dollar health care deal was enacted during the early morning on January 16, 2002, in great haste and secrecy without any public hearings, no experts testifying on the proposal and with few rank and file legislators involved in the negotiation process. It was a classic back room deal.

Hospitals are slated to get about $700 million in state money over the next three years to boost salaries and take other steps to recruit workers. Money for hospitals and nursing homes will be distributed evenly to institutions across the state, based on the size of their payrolls, and may be used for recruiting or retaining any non-supervisory personnel.

• Hospitals will receive $696 million over three years to be used for recruitment and retention activities of which $651 million will be distributed as a Medicaid rate add-on unique to each facility and $45 million will be allocated over three years as a competitive recruitment and retention grant program for hospitals.

• Nursing homes will receive $288 million over three years via a similar Medicaid rate add-on unique to each facility. A nursing home grant program to enhance quality of care through improved staffing would add another $62 million per year for three years. Nursing homes demonstrating financial need may qualify for additional grant funding totaling $30 million over three years.

• Home care will receive- $964 million over four but $895 million of it will go to New York City's home attendant program

The Campaign for Healthy Children was successful in advocating the following program simplifications in the Child Health Plus A and B programs which were included in the bill.

• Mail in renewals for children in Child Health Plus A (children’s Medicaid) program.

• Self-attestation of income for children renewing in CHP B.

• A new simplified renewal form for CHP A and B.

• Elimination of the documentation requirement for social security numbers.

• Providing a two-month grace period for completion of paperwork for CHP B renewals.

The legislation also includes funds for:

• the creation of a foundation dedicated to improving health care access for New Yorkers;

• community health centers;

• prescription drug coverage for low-income seniors;

• expanded Medicaid coverage for the disabled; and

• excess malpractice insurance for doctors.

To pay for these programs the legislation:

• hikes cigarette taxes by 39 cents per pack, to a total of $1.55; generating an estimated $789 million over three years;

• extracts an estimated $1 billion from the conversion of Empire Blue Cross & Blue Shield to a for-profit company;

• imposes a 6 percent surcharge on nursing home revenues to raise $300 million a year; and

• anticipates a federal Medicaid formula increase from 50% to 53% generating $1.8 billion more in federal Medicaid money.

The administration did not put a price tag on the bill but estimates range from $3.5 billion to $4.5 billion over an uncertain number of years. The bill was passed because of the enormous political clout of Dennis Rivera, the head of SEIU 1199 health care workers union in New York City.