Public Health Law on Lead testing, June 20, 2009 

If you are a healthcare provider with pediatric patients, you should know about the recent changes to Public Health Law and regulations that pertain to childhood blood lead testing, reporting, and follow-up.  Unless otherwise noted, these changes went into effect June 20, 2009.

The changes for childhood lead testing and reporting include the following:

• Clarify that the term “screening” refers to blood lead testing. Under existing regulations, which remain unchanged, health care providers are required to test all children for lead at age one and again at age two years.  They must also assess all children age six months to six years for risk of lead exposure at least annually as part of routine care, and provide a blood lead test if a risk is identified; 

• Authorize private Physician Office Laboratories (POLs) and limited service registrant laboratories to conduct blood lead testing using test devices of complexity appropriate for their level of federal certification, and require these labs to report all blood lead test results to the NYS Department of Health. Note that even with these changes, any entity performing laboratory procedures must be appropriately registered and meet applicable standards/requirements, available on the DOH Web site at: http://www.wadsworth.org/docs/overview_lab_quality.shtml.  Additional details on blood lead test reporting requirements will be distributed to laboratories;

• Require that health care providers confirm capillary blood lead test results ≥ 10 micrograms per deciliter (µg/dL) using a venous blood sample. Note that additional standards for use of CLIA-waived portable lead testing devices require confirmation of all results > 8 µg/dL;

• Eliminate use of the term “certificate of lead screening”. The revised regulations clarify that any written statement signed by a health care provider satisfies the requirement for providing documentation of lead screening to parents and child care providers;

• Allow for linkages between the statewide childhood lead registry (LeadWeb) with the New York State Immunization Information System (NYSIIS).  Lead testing information will be displayed for health care providers and other authorized users in NYSIIS, and Physician Office Laboratories (POLs) that conduct blood lead testing on children in their offices will be required to submit test reports to the statewide lead registry through NYSIIS beginning September 1, 2009.

Changes for follow-up services for children with elevated blood lead levels (EBLLs) include the following:

• Require health care providers to provide comprehensive follow-up services for all children with blood lead levels (BLLs) ≥15 µg/dL.  Comprehensive follow-up services include: lead exposure assessment, developmental screening, nutritional assessment, medical management as necessary and referral to the state or local health department for environmental management. This expands the previous criteria for these services of 20 µg/dL;

• Require local health departments to provide environmental management for all children with BLLs > 15 µg /dL. This is also an expansion from the previous criteria of 20 µg/dL;

• Clarify that follow-up services are required for all children with EBLLs up to age eighteen years.  Although routine blood lead testing is not recommended or required for children age six years and older, health care providers may choose to test older children and youth if a risk is identified, and appropriate follow-up must be provided for any child found to have lead poisoning;

• Expand the requirements for immediate notification of critically elevated BLLs to include all children less than eighteen years of age. Laboratories must notify the health care provider ordering the test of BLLs > 45 µg/dL for all children under the age of eighteen years within 24 hours of analysis. Health care providers in turn must notify the local health department of BLLs ≥ 45 µg/dL for all children under the age of eighteen years within 24 hours of notification by the laboratory. Previous regulations required these urgent notifications only for children less than six years of age.

All pediatric health care providers are encouraged to read a more detailed description of the changes and a letter from the Department of Health on the NYSDOH Web site at: www.nyhealth.gov/environmental/lead.   There you will also find risk assessment questions, patient education materials, and the complete text of the amended law and regulations.

For additional questions, contact the New York State Lead Poisoning Prevention Program at 518-402-5706.
___________________________________________

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.

___________________________________________

"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.

___________________________________________

New York Physician Alliance

In 2005 state legislation created a Pay for Performance (P4P) Demonstration program to facilitate multi-payer collaborative. The statute directed the Commissioner of Health to convene a workgroup of providers and payors to develop a list of clinical measures and metrics to measure provider performance. The New York Quality Alliance (NYQA) is the statewide multi stakeholder collaborative developed as a part of the DOH grant, and is responsible for developing a uniform data aggregation and reporting process that will promote statewide quality performance improvements among health care practitioners. The Physicians’ Alliance (PA) is the group of physician representatives organized to oversee the project from a physician’s perspective. An update on the PA was distributed in the first Physician Alliance Newsletter, and further information is available on the NYQA web site.
                                                          

___________________________________________

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

___________________________________________

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.