BULLET IN STATE PSYCHIATRIC ASSOCIATION 2012, Vol. 56, #1 • Bringing New York State Psychiatrists Together Albany Report Medicaid Redesign & the Public By Richard J. Gallo, Barry B. Perlman, MD and Jamie Papapetros Mental Health System in NYS By Barry B. Perlman, M.D. Governor Lays Out Agenda for 2012 Legislative Session in State of State Address n my last piece for the NYSPA changed to PROS (Personalized Basking in the glow of the successes of the 2011 Legislative Session, Governor Bulletin I presented an overview of Recovery Oriented Services) programs; Cuomo delivered his second State of the State address – an ambitious roadmap Ithe attack on Medicaid, including transition of the NYS Medicaid formu - that largely focused on revitalizing the State’s economy and spurring job creation. mental health services, taking place lary to a series of Medicaid HMO based Calling it a blueprint for a New New York, the Governor outlined several specific across the nation. I expressed my belief formularies and a limited formulary for agenda items for the 2012 Legislative Session including: that given New York State’s expendi - those enrollees remaining in the • Closing a $2 billion budget deficit without any new taxes or fees. tures on Medicaid, which are far higher Medicaid Fee For Service (FFS) system than any other state, reductions were and elimination of the long standing • Continuing the consolidation of State agencies and authorities, as recommend - necessary although not welcome in the ed by the Governor’s Spending and Government Efficiency (SAGE) statutory requirement that when a dif - current dismal economic climate. We ference exist between a physician and a Commission, including the merger of the Office of Mental Health and the are fortunate that the changes in New Office of Alcoholism and Substance Abuse Services. Details of this re-organiza - Medicaid formulary, the “physician pre - York are being implemented in a vails”; the process of moving all of tion are expected to be unveiled in the Governor’s budget proposal for 2012-13. thoughtful manner meant to preserve • Passage of legislation establishing an insurance exchange pursuant to the federal those covered under the Medicaid FFS the gains made in the delivery system in system to a fully managed system; initi - healthcare reform law. recent years and, perhaps, even to ation of a process of creating Health improve that system of care. The complete text of the State of the State address can be downloaded at: Homes to provide varying intensities of http://www.governor.ny.gov/assets/documents/Building-a-New-New-York-Book.pdf The 2011 New York State budget includ - case management for a “high user” pop - ed wide ranging budget reductions to ulation composed of persons with seri - MEDICAID REDESIGN TEAM since its inception.” the Medicaid program. These changes ous and persistent mental illness SUBMITS FINAL REPORT: The last meeting of the MRT was held included but were not limited to: a 2% (SPMI) and/ or chronic medical dis - Work Groups’ Recommendations on 12/13/11 to receive and approve the reimbursement cut for hospitals, includ - eases. Advance to the Governor recommendations of the remaining four ing most mental health services, both The work of fostering the wide ranging Established by Executive Order on of the nine Work Groups: inpatient and outpatient; creation of thresholds for outpatient mental health transformation of the mental health sys - January 5, 2011, the Medicaid Redesign • Basic Benefit Review Work Group tem and the Medicaid system more Team (MRT) concluded its year-long • Workforce Flexibility and Change of and drug & alcohol visits which when exceeded result in automatic reimburse - broadly is being developed under the assignment and issued its final report Scope of Practice Work Group aegis of the semitransparent/semi on 12/31/11, concluding that the rec - • Payment Reform Work Group ment reductions; reduction of reim - bursement for Continuing Day opaque MRT (Medicaid Redesign Team) ommendations, if implemented, consti - • Affordable Housing Work Group process and its Behavioral MRT sub - tute “the most significant overhaul of Treatment Programs (CDT) to the the New York State Medicaid program [See Albany Report on page 5] extent that many were shuttered or [See Medicaid Redesign on page 6] Legislative Brunches Fall NYSPA Council Meeting By Rachel A. Fernbach, Esq. By Rachel A. Fernbach, Esq.

he New York County District duced Carol Bernstein, M.D., APA he New York Branch of the APA hosted its 13th Immediate Past-President; Glenn State T Annual Citywide Josef Weissberg Martin, M.D., NYSPA President; and T Psychiatric Legislative Breakfast on December 4, Jack Hirshowitz, M.D., Chair of the Association held its 2011, at the New York Academy of NYCO Legislative Committee. Finally, annual Fall NYSPA Medicine in New York, New York. One Dr. Katz introduced New York State Council Meeting on week later, the Psychiatric Society of Assembly Members (D- Saturday, October 15, Westchester hosted its 25th Annual ) and Brian Kavanagh (D- 2011 at the New York Legislative Brunch on December 11, Manhattan). LaGuardia Airport Marriott Hotel in 2011, at the Crowne Plaza Hotel in The members of the panel discussed a East Elmhurst, New White Plains, New York. variety of issues regarding proposed Breakfast York. Glenn Martin, changes to the Medicaid managed care M.D., NYSPA The planning committee for the New system, which will move all Medicaid President, called the York City event adopted a new and beneficiaries into a managed care plan. meeting to order and exciting format this year. The organizers The Medicaid program plans to estab - welcomed Council invited a panel of experts to discuss pro - lish behavioral health organizations guests. After the call James Nininger, M.D., Seeth Vivek, M.D., M. Mercedes Perez- posed changes to the Medicaid managed (BHOs) which will coordinate care for to order, various Rodriguez, M.D., Aaron Satloff, M.D., Russell Denea, M.D. care system and the expected impact on individual with serious and persistent members of the NYSP-PAC financial statement for individuals with serious and persistent mental illness (SPMI), traditionally high Council provided reports. January-October, 2011, comparisons mental illness. The panel included New volume users of the Medicaid system. Richard Altesman, M.D., NYSPA for the same time period for 2010 and York State Assemblymember Richard As individuals are transitioned out of Secretary, presented minutes from the 2009, and the list of contributors so far Gottfried (D-Manhattan); Michael fee-for-service Medicaid, mental health March 26, 2011 meeting of the NYSPA this year. Hogan, Ph.D., Commissioner, NYS professionals must work to ensure that Council, which were approved. NYSPA In his President's Report, Dr. Martin Office of Mental Health; Andrea Cohen, access to medically necessary care, treat - Treasurer Jeffrey Borenstein, M.D. pre - provided an update on a variety of Director of Health Services, Office of the ment and medications are not compro - sented NYSPA financial statements for Council issues. He confirmed that no Mayor, New York City; and Ann mised. January-September 2011 with a com - additional cuts have been made to the Sullivan, M.D., Senior Vice President, The panel discussed the need to preserve parison for the same period for 2010 New York State Delegation to the APA Queens Health Network, NYCHHC. safety net institutions as well the and 2009. Dr. Borenstein reported that Assembly and that the number of rep - the $15 dues increase slated for 2012 The event was moderated by Barry [See Legislative Brunches on page 4] resentatives remains at 14. Dr. Martin Perlman, M.D., Chair should begin to have an impact in the announced that the Assembly Speaker, of the NYSPA next billing cycle. He also noted that Ann Sullivan, M.D., has formed a spe - Committee on the new APA credit card installment cial Planning Committee to review the Legislation and NYSPA payment plan for dues has affected the structure of the Assembly and deter - Past-President. timing of anticipated revenues. Finally, mine whether it is best suited to repre - Dr. Borenstein noted that due to very Craig Katz, M.D., sent and serve the needs of APA mem - low CD rates, NYSPA has decided not bers. Dr. Martin noted that he was President of the New to reinvest any funds at this point and York County District pleased to have been appointed a will wait to see if rates shift in the near member of this committee. Branch welcomed future. everyone and shared a Dr. Martin announced that NYSPA and Budget Committee Chair Aaron Satloff, memory of Josef MSSNY have collaborated to improve M.D. presented the 2012 NYSPA budg - membership in both organizations and Weissberg. He wel - et, which included very little change comed Richard that MSSNY has agreed to offer from the prior year. The Council voted reduced dues for the first two years of Stagnato from PRMS to adopt the 2012 budget. Edward and thanked PRMS for membership for any APA member who Gordon, M.D., Chair of the Political joins MSSNY. its support of today's Action Committee, presented the event. Dr. Katz intro - Panelists at the NYC event [See Council Meeting on page 3] THE BULLETIN FROM THE EDITOR’S DESK... By Jeffrey Borenstein, MD NEW YORK STATE his edition of the events, including a panel Contest. The Area II Trustee Report PSYCHIATRIC Bulletin focuses on a of experts discussing highlights key issues addressed at ASSOCIATION T number of key leg - changes to Medicaid. We the APA Board of Trustees meeting. islative and regulatory also have an article which We are also pleased to announce issues. The Albany Report examines Medicaid Re- that Barry Perlman, M.D., NYSPA Editorial Board reviews issues related to design. In addition, we Legislative Chair and Past President, Jeffrey Borenstein, MD Medicaid, workforce and report on the Fall NYSPA has been asked to serve as Chair of Editor-in-Chief scope of practice, and pari - Council Meeting which the Behavioral Health Task Force for Holliswood Hospital ty implementation. The included a presentation HANYS. I 87-37 Palermo Street report on the legislative by the winner of the Queens, NY 11423 branches reviews these Jeffrey Borenstein, MD NYSPA Scientific Paper Tel: (718) 776-8181 ext. 321 Fax: (718) 776-8551 e-mail: [email protected] http://www.nyspsych.org/bul - Area II Trustee’s Report: APA Practice Guidelines: Where letin/Pages/default.aspx Manoj Shah, MD By James Nininger, MD Ann Sullivan, MD he APA Board of need to educate our mem - in Washington D.C. this winter to pro - Rachel A. Fernbach, Esq. Trustees met Decem- bers and the public about vide participants with an update on Assistant Editor T ber 10-11, 2011. the range of communica - proposed legislation relevant to psychi - Robert J. Campbell III, MD Following are some of the tions of this nature occur - atry and an opportunity to lobby mem - Editor-in-Chief Emeritus major issues addressed. ring and to provide guide - bers of Congress directly. Funding in The preparation and evolu - lines about what might be the APA budget for this year provides Leslie Citrome, MD, M.P.H. tion of DSM-5 continues considered appropriate an opportunity to increase the number Editor-in-Chief Emeritus with plans for its release in treatment. of residents invited. May of 2013. Introductory In his Medical Director’s APA has hired a new Director of New York State Psychiatric chapters include topics report, Dr. Scully reported Publishing, Becky Rinehart, who is James Nininger, MD Association such as: the emergence of that 85% of the APA website active in developing on-line strategies 400 Garden City Plaza, Suite 202 neuroscience/medical biomarkers, redesign is completed and will be and working to revitalize Psych News. Garden City, NY 11530 development across the life span, gen - launched in 2012 (“Psychiatry.org”). From a survey of psychiatrists, 45% did (516) 542-0077; Fax: (516) 542-0094 der and psychiatric diagnosis, culture Through tight management, APA’s cuts not know that Psych News is available e-mail: [email protected] and psychiatric diagnosis, the need for in expenditures have outpaced decreas - on-line. Advertising revenues this year http://www.nyspsych.org quantitative (dimensional) measures, es in revenue, allowing a surplus for the actually increased in part due to new and ICD (International Clarification of year. Any further decreases in staff fund - on-line subscriptions. Executive Committee 2010-12 Disease) and WHO (World Health ing, however, would require cutting cur - Revenue from the pharmaceutical Glenn Martin, MD , President Organization) coordination. There will rent programs. APA currently has a FTE industry peaked in 2006 at 18 million Seeth Vivek, MD, Vice President be approximately 80 short chapters on roster of 225 positions (was at a peak and was approximately 6 million for Richard Altesman, MD, Secretary various disorders. A Scientific Review in 2008 of 265). The year 2012 may 2011, a two-thirds reduction over five Jeffrey Borenstein, MD, Treasurer Work Group chaired by Dr. Kenneth prove to be a period of uncertainty for years. Though many value our James Nininger, MD, Area II Trustee Kendler is reviewing proposed changes the APA. The Annual Meeting in Hawaii decreased financial reliance on industry, Seth P. Stein, Esq., Executive Director to the Diagnostic Manual from the showed an increase in course registra - creative approaches are needed to find C. Deborah Cross, MD, Past President standpoint of the scientific evidence tion but overall attendance was down other sources of revenue and other available, and additionally, proposed and industry support minimal. avenues to provide education, opportu - Information for Contributors changes are being reviewed where Philadelphia has in the past been a nities for research and collegiality for good location for Annual Meeting suc - The Bulletin welcomes articles and appropriate by a clinical and public our members. cess and the figures in May 2012 will be letters that NYSPA members will health committee chaired by Drs Joel Finally, the psychiatric delegation to the Yaeger and Jack McIntyre regarding of interest and revealing. National find timely, relevant, and compel- AMA (APA Section Council and State practical difficulties that might be membership is now between 32,000 Delegates) has come to play an increas - ling. Articles should be between involved in any changes. An Assembly and 33,000 (was 34,000 at the end of 750 and 1500 words (three to five ingly important role in shaping AMA Liaison Committee chaired by Dr. last year). There have been some policy, and several APA members hold double-spaced manuscript pages) Glenn Martin is providing feedback on decreases in MIT membership and and letters no more than 750 prominent positions. This year, Jeremy how the document might most help cli - international membership numbers. Lazarus, M.D., former speaker of the words. All submissions must be nicians. To date, 17 million dollars Major efforts are being made to analyze Assembly, has been elected (un- made electronically, preferably by have been spent out of a proposed the various reasons for current trends opposed) as President-Elect of the AMA email to the editor. All authors are budget of 25 million. and to take positive action to make – the first psychiatrist to attain that encouraged to also provide a pho - Dr. Paul Summergrad chairs an Ad Hoc improvements. position in nearly 100 years. tograph of themselves which will Work Group on the Role of n the Advocacy area, a central concern We are a part of Medicine and must be be printed alongside their article. Psychiatrists in Health Care Reform, remains the need to fix the sustainable at the table in any discussions of and provided a preliminary report. growth rate (SGR) formula for Health Care Reform, Integrated Care, Information for Advertisers Issues such as the possible role of psy - Medicare. Without doing so, each time the appropriate use of Electronic Health The Bulletin welcomes advertise- chiatrists in the patient-centered the proposed Medicare cuts are post - Care Records, Maintenance of ments from both NYSPA members Medical Home, the emerging role of poned, the debt incurred (owed by the Certification, implementation of parity and commercial enterprises. Total performance measures, the state of the doctors) increases. As Dr. Scully has legislation, etc. Your APA has groups circulation averages 5,500 copies use of Electronic Health Records, the said “If this keeps going, we'll be pay - active in all these areas and there is per issue. The Bulletin is received by increase in cost of care because of psy - ing to see patients.” Significant reduc - ample opportunity for involvement if members of the American chiatric co-morbidities, and the evi - tions for psychiatrists who participate you wish. dence base for Integrated Care models in Medicare (of which I am one) would Psychiatric Association who belong A summary of recent Board actions and to a district branch in New York are being studied. lead to large numbers of physicians “opting out” and severely harm access the most recent Medical Director’s State. The Bulletin is also sent to the Dr. Mary Helen Davis chairs a Work Report is available at www.psych.org Group on Maintenance of (Board) to care for the elderly and disabled. leadership of other district branch - There will again be an “Advocacy Day” under Resources/Governance/Board of es across the and to Certification (MOC). Other sub-special - Trustees. I New York State legislators, medical ties have been addressing this move - ment, and psychiatry needs to have a libraries, and science writers. The clear sense and statement of its place in Bulletin is published quarterly. these procedures, particularly where Both classified advertisements and specific practice exemptions and exclu - Announcement display advertisements are avail - sions might apply. Psychiatrists have Barry B. Perlman, M.D. has been asked to serve as Chair of the able. Please contact the editor for concerns about the performance-in- Behavioral Health Task Force for HANYS, the Hospital Association current rates and media require - practice (PIP) requirements being con - ments. NYSPA members receive a sidered for patients’ reports of their of New York State, for a two-year period beginning January, 2012. discount of 50% off the basic clas - doctors’ effectiveness in treatment. As Dr. Perlman is the Legislative Chair and a Past-President of NYSPA. sified ad rate. over 25% of psychiatrists are not Board He explained that he looks forward to working with HANYS on Certified, they too will be required (on The opinions expressed in the arti - issues impacting mental health care in New York State and the role a state-to-state basis) to justify mainte - played by departments of psychiatry and behavioral health in our cles or letters are the sole responsi - nance of their licensure (MOL). Some bility of the individual authors, hospitals may additionally require their state’s system of care. Many NYSPA members are employed in insti - and may not necessarily represent own certification criteria. The hope is tutions that are members of HANYS. One example of an area in the views of NYSPA, its members, the more effectively we can regulate which HANYS may be able to work collaboratively with NYSPA and or its officers. ourselves, the less we will be regulated the APA is the ongoing effort to realize the promise of the MHPAEA, by government intrusiveness. the federal Mental Health Parity and Addiction Equity Act within Graphic Design & Production E-Therapy (psychotherapy on the Lydia Dmitrieff Internet) models have been proliferat - New York State. Dr. Perlman is the Director, Dept. of Psychiatry, A to Z Design Group ing, and there was discussion about the Saint Joseph’s Medical Center in Yonkers, N.Y.

Page 2 New York State Psychiatric Association • THE BULLETIN Council Meeting continued from page 1 Dr. Martin acknowledged Dr. Sullivan federal government still has not Mr. Stein provided an update on process. The proposed changes will be for her work as a member of the approved the state plan amendment NYSPA's parity efforts. NYPSA has con- voted on at the upcoming Assembly Medicaid Redesign Team's (MRT) that would permit the new APG system tacted EmblemHealth, who is now part- meeting. Behavioral Health Workgroup and also to go into effect. At the same time, the nered with ValueOptions, regarding Area II Trustee's Report acknowledged Richard Gallo and Jamie COPS system is being phased o ut with submission of evaluation and manage- James Nininger, M.D., Area II Papapetros for their continued moni- nothing to replace it, which puts clin ics ment claims by psychiatrists. In Representative to the APA Board of toring of the work of the MRT. He also in a dire financial position. response, EmblemHealth stated that it Trustees, provided an update on APA reported that NYSPA has drafted a letter Finally, Dr. Perlman reported on the does not plan to reimburse evaluation Practice Guidelines and ongoing efforts to State Mental Health Commissioner proposed redesign of the Medicaid sys- and management codes submitted by to improve the guideline development Michael Hogan expressing concerns tem, which will move all Medicaid ben- psychiatrists at the same rate as evalua- process. He also provided an update about OMH's policy regarding use of eficiaries from fee-for-service Medicaid tion and management codes submitted on APA finances. Staff vacancies have ECT in children and adolescents. into a managed care model. The men- by all other physicians. This is a clear created a surplus and the reserve fund is Finally, Dr. Martin announced that tal health community continues to have violation of the parity rules and NYSPA in good shape. There have been signifi- NYSPA wrote a letter to the Editor of grave concerns regarding how the needs plans to pursue this issue with federal cant expenditures with regard to the the New York Post decrying a recent of those with serious and persistent and state regulators. In addition, development of DSM-5, which will also article regarding Medicaid redesign that mental illness will be addressed under NYSPA has been advised by the NYS generate significant revenue upon com- disparaged individuals with mental ill- the new system. Department of Financial Services, pletion. DSM-5 is currently in field tri- ness and substance use disorders. The Richard Gallo, NYSPA Government which now includes the Department of als in the second level of review. New York Post declined to publish Insurance, that the best way to enforce Relations Advocate, announced that the Assembly Update NYSPA's letter but it has been posted NYSPA Legislative Report and a list of parity implementation is to file individ- Ann Sullivan, M.D., Assembly Speaker, on the NYSPA website for anyone inter- bills of interest will be made available ual complaints with the DFS Consumer announced that the Assembly meeting ested. on the NYSPA website. NYSPA's legisla- Affairs Office. All NYSPA members in November will include new breakout American Professional Agency, Inc. tive agenda for the upcoming ye receiving denials are encouraged to ar sessions from 3:00-4:30 pm on Cindy Tunney from the American includes the following issues: (i) a bill request from each plan copies of the Professional Agency, Inc., the new APA- that would require hospitals to provide criteria used to make endorsed malpractice insurance carrier, for continued malpractice insurance for medical necessity provided members with an update. its physicians in the event the hospital determinations. If American Professional Agency has now declares bankruptcy; (ii) reinstatement plans refuse to dis- received approval of its rates, which are of prescriber prevails in the Medicaid close their criteria or very competitive at 4% lower than program; (iii) ensuring that patients be if their policies other programs. They are also awaiting permitted to assign payment over to a appear to violate the approval of a 5% risk management dis- health care provider even if the provider parity rules, mem- count. Ms. Tunney confirmed that is not an in-network provider under the bers are encouraged there is no penalty to switch from a patient's health insurance plan; and (iv) to contact NYSPA previous carrier, members will receive legislation supporting collective negoti- Central Office for credit for time with a previous carrier ation by physicians. Finally, Mr. Gallo guidance. and that members can start with announced that NYSPA plans to host a Finally, Mr. Stein American Professional Agency at its first Legislative Day in Albany in 2012 and reported on recent year rate even if the member has tail to keep an eye out for more informa- changes to the coverage from a previous carrier. She tion. Medicaid system in Ann Sullivan, M.D. and Scott Benson, M.D. reported that American Professional New York State. NYSPA Scientific Paper Contest Saturday. She encouraged everyone to Agency offers coverage for fire damage Going forward, all individuals with seri- Seeth Vivek, M.D., announced the participate in the breakout topics, up to $150,000, including costs of ous and persistent mental illness will results of the 4th Annual NYSPA which will include DSM-5, defense, and coverage of medical bills be transferred from fee-for-service Scientific Paper Contest: Communications, Mentorship, up to $25,000. Finally, Ms. Tunney Medicaid into a managed care environ- 1st Place: M. Mercedes Perez- Legislation, Access to Care, reported that there is ment. Care will be provided and man- Rodriguez, MD, Maintenance of Certification no additional sur- aged by a behavioral health organiza- and Mount Sinai Practice Guidelines. Dr. Sul charge for ECT or tion that will receive reimbursement livan Medical Center reported that all members telepsychiatry. based on a capitation rate for each indi- of the Board "Striatal Activity in vidual served. This capitation rate of Trustees are expected to attend the Legislative Report B orderline model represents a sea change in how upcoming Assembly meeting and that Barry Perlman, M.D., Pe rsonality Medicaid providers will be reimbursed the Board will be meeting with the Chair of the Disorder: Sex in the future. Assembly Executive Committee over the Committee on Differences" weekend. In addition, Board members Legislation, reminded NYSPA Policy for Disclosure of will be visiting Area Council meetings 2nd Place: Anna Interests and Affiliations the Council that Dickerman, M.D., to observe and listen in. NYSPA has a regular Weill Cornell Dr. Vivek, Chair of the Ad Hoc Scott Benson, M.D., Assembly Speaker- column in the Mental Medical Center Committee on a NYSPA Conflict of Elect, reported that the APA has recently Health News. If any- "Abnormal Interest Policy, presented the proposed established a LinkedIn account and one has a suggestion Thyroid function- NYSPA Policy for Disclosure of Interests encouraged all members to join. He M. Mercedes Perez-Rodriguez, M.D., pre - or idea for a column ing in Psychiatric and Affiliations. Dr. Vivek summarized hopes the LinkedIn account will pro- topic that would be senting her winning paper. patients: a red her- the proposed policy and thanked Herb vide members with a forum to discuss educational for con- ring?" Peyser, M.D., for serving on the com- issues on a large scale. He also noted mittee with him. He encouraged all sumers and patients, please contact 3rd Place: Dr. Zimri that he is very excited about the break- Yaseen, M.D., district branches to consider adopting him. Dr. Perlman provided an update Beth Israel Medical out sessions scheduled for the upcom- Center similar conflict of interest policies as on NYSPA's parity compliance efforts "Brain Activity in Depr ing Assembly meeting and hopes every- ession, well. Following discussion, the Council and reported that NYSPA has been Insecure attachment" one will participate. working closely with the APA on this voted to adopt the NYSPA Policy for Action Papers issue. Also, NYSPA has been contacting Dr. Perez-Rodriguez, the First Place win- Disclosure of Interests and Affiliations. ner, received a pla health plans directly to address areas of que and a $500 cash NYSPA Reorganization Proposal The Council discussed the following prize and was given the opportunity to action papers that will be reviewed by concern as well as consulting with the The Council reviewed the NYSPA NYS Department of Financial Services present her paper to the Council. Dr. the Assembly in November: (i) Vivek reported that 15 papers were sub- Reorganization Proposal, which had Endorsement of the Convention for the (which now includes the Department been tabled from the Spring 2011 of Insurance). NYSPA is hoping to set mitted from a variety of residency pro- Elimination of All Forms of grams throughout the state and that all Council meeting. The Reorganization Discrimination Against Women; (ii) up a meeting with representatives from Proposal includes revisions to the the NYS Department of Health to identifying information was removed Continuing support for the APA Public from the papers before review. He NYSPA Code of Procedures required as Psychiatry Fellowship; (iii) Provision of address the lack of compliance by many a result of recent reductions in the Medicaid managed care plans. In addi- thanked the judges, Aaron Satloff, Formalized Mentorship for Members- M.D., Russell Denea, M.D. and James number of New York State representa- in-Training (MIT) in the Assembly; (iv) tion, NYSPA has been corresponding tives to the APA Assembly. The revi- directly with Hudson Health Plan and Nininger, M.D. for their assistance and Reinstating the APA State Legislative participation. sions include (i) a new method for Institutes; and (v) APA Documentation Beacon Health Strategies, its behavioral determining the members of the New Executive Director's R Templates. health partner, regarding parity imple- eport York State Delegation to the Assembly mentation. Seth P. Stein, Esq., NYSPA Executive and (ii) in an effort to increase local New Business Dr. Perlman announced that the Director, provided an update on the representation at the Council level, the Edmund Amyot, M.D., announced that Governor's office vetoed a recent bill Medicare RUC Committee and its 5 addition of District Branch Presidents the next meeting of the MSSNY House proposing additional due process rights year review of CPT codes. NYSPA and as voting members of the NYSPA of Delegates will be held in Saratoga for health care professionals who are other parties have suggested that code Council. Following discussion, the Springs, New York, in April 2012. being investigated by the Office of 90862 be eliminated because it is reim- Reorganization Proposal was adopted. The meeting was concluded with bursed at Medicaid Inspector General. However, a lower rate than comparable APA Election Guidelines reports from the following NYPSA the Governor's office has formed a evaluation and management codes. Mr. Robert Kelly, M.D., Chair of the APA Committees: Psychiatry and the Law, committee to look into the issues ide Stein noted that he has been authorized n- Election Committee, presented pro- Public Affairs, Public Psychiatry, and tified in the bill. He also repo to disclose that this suggestion has been rted on posed changes to APA Election MSSNY Committee on Psychiatry and the new APG payment system for opposed by the 73 psychologists in the I Guidelines designed to streamline and Addiction Medicine. Article 31 clinics that went into effe United States who have been granted ct update the campaign and election on October 1, 2010. Unfortunately, the prescribing privileges by their state.

New York State Psychiatric Association • THE BULLETIN Page 3 Legislative Brunches continued from page 1 involvement of the provider communi - Presbyterian Hospital and that he is ty in ensuring the success of a managed committed to retaining core services for care model, especially for those with the mentally ill and ensuring that SPMI. Commissioner Hogan noted health care professionals are compen - and other panelists agreed that a good sated for their valuable services. managed care system is one where real - Dr. Katz concluded the New York City ized savings are reinvested back into the event by thanking the panelists for their system to improve care and outcomes time and insightful comments. He and that an ideal system is one reminded those assembled that the designed with the needs of patients in New York County District Branch par - mind. Ms. Cohen echoed that senti - ticipates annually in a community pro - ment, stating that the system should gram called One for All, aimed at focus on integrated care and that a silo improving mental health in the com - model does not necessarily best serve munity. Each year, participating District the needs of the individual. Branch members donate their time, The panelists discussed the October 1, equivalent to one patient hour, to a 2011, "carve-in" of the Medicaid phar - community organization. This year, the macy benefit into individual managed designated organization is GLSEN, the care plans and uniformly expressed Gay, Lesbian & Straight Education concerns about the change. Network. He encouraged all members They noted that the new carve-in has to participate. The Westchester Legislative Brunc created a "Tower of Babel" approach, Westchester Brunch resulting in a myriad of different rules, The Westchester brunch, which took impacting Medicaid enrollees. transfer of 1,200 patients over to private requirements and available medications place the following week, was moderat - On the federal side, Dr. Perlman noted not-for-profit clinics. This decision to from plan to plan. Under the newly ed by C. Deborah Cross, M.D., that NYSPA is continuing to work dili - close the county clinics generated $3 deconstructed system, patients and psy - President of the Psychiatric Society of gently to ensure full implementation of million in savings and strengthened the the federal parity law and regulations. private non-profit clinics, which are NYSPA plans to contact state and feder - now able to serve new patient popula - al legislators to ask for assistance in tions. The successful transition is an communicating with federal and state excellent example of what can be regulators about key areas of concern. accomplished when government, the Dr. Cross then welcomed New York business sector and the not-for-profit State Senator Andrea Stewart-Cousins sector work together. (D-Yonkers), New York State Assembly Dr. Mitchell also reported on a new Members George Latimer (D- county initiative to provide mobile cri - Mamaroneck) and (D- sis services with a focus on prevention, White Plains), and Pat Keegan, a repre - early intervention and ancillary services sentative from the office of U.S. to help patients, particularly children, Congresswoman Nita Lowey. She also avoid emergency room visits. Finally, introduced Grant Mitchell, M.D., Dr. Mitchell discussed the county Police Commissioner of the Westchester County Department of Community The New York City Legislative Breakfast Mental Health and Susan Stabinsky, M.D., Westchester Legislative Chair. chiatrists will be forced to navigate a Westchester and NYSPA Past-President. complicated web of rules where one Dr. Cross welcomed Remy Palumbo The first legislator to address the group medication may be included in the for - from PRMS and thanked PRMS for its was Assemblyman Robert Castelli who, mulary of one plan but not included in support of the event. She acknowl - as a relatively new member of the the formulary of another. Switching edged other NYSPA Past-Presidents Assembly, noted that 2011 has proven between managed care plans may force Edward Gordon, M.D. and Barry to be a year of improvement, with evi - individuals to change medications, Perlman, M.D. dence of greater cooperative capabilities among state leaders and legislators. which may result in destabilization and Dr. Perlman, Chair of the NYSPA other dire consequences for individuals Assemblyman Castelli noted that Legislative Committee, was very pleased Medicaid expenditures represent the with serious and persistent mental ill - to report that the event marked the ness. single largest portion of the New York 25th year that the Psychiatric Society of State budget and that revisions to the Next, the panel discussed the future of Westchester has hosted a legislative Medicaid system should not be taken public psychiatry and need to cultivate Snator Andrea Stewart-Cousins brunch. He continued by providing an lightly. He encouraged all members to young psychiatrists feel free to stop by his offices if they interested in the have any concerns or questions. Ride-Around Program, which pairs field, which truly social workers with police officers spe - needs renewed talent Next, Senator Andrea Stewart-Cousins cially trained in responding to persons and energy. Finally, addressed the group, discussing with behavioral issues. The recently the panel answered Medicaid redesign and the importance expanded program, which encourages questions from the of ensuring that the most vulnerable police to utilize verbal techniques audience. and marginalized popu - lations have a voice in Following the panel the process. Senator discussion, Stewart-Cousins con - Assemblyman David cluded her remarks by Weprin addressed the stating that she is com - group, noting that mitted to working prior to his time in towards solutions. the Assembly, he served on the New Assemblyman George York City Council for Assemblyman Robert Castelli, C. Deborah Cross, MD, Barry Latimer took the podi - eight years. He stated Perlman, MD um next and discussed that he was very the state budget process involved in supporting the passage and overview of issues facing psychiatrists in and current efforts to implementation of Timothy's Law and New York, including sweeping changes redesign the state will continue to work hard to ensure to the Medicaid program and transfer Medicaid system. He stated that he looks for - that mental health services are not cut of all Medicaid beneficiaries into Assemblymember George Latimer, Barry Perlman, MD, Mark ward to working with back in the future. Medicaid managed care plans. It is Cannon, MD organized psychiatry to Assemblyman Brian Kavanagh spoke important that organized psychiatry identify specific issues and areas of con - next, stating that he serves the east side play a central role in these changes to instead of physical interventions and cern after the 2012-2013 budget is pre - of Manhattan and that there are several ensure that access to care for persons arrests, creates a powerful interface sented. health care facilities in his district. He with mental illness is protected and between the criminal justice system and noted that in the past he worked with that any savings achieved are reinvested Next, Grant Mitchell, M.D., addressed the mental health system. indigent families on the Lower East back in the system. Dr. Perlman also the group. Dr. Mitchell is a psychiatrist The event was concluded with a ques - Side of Manhattan who were affected discussed the carve-in of the Medicaid who serves as the Commissioner of the tion and answer period. I by mental health issues. Assemblyman pharmacy benefit and reported that the Westchester County Department of Kavanagh also noted that his sister is a Assembly Committee on Health is host - Community Mental Health. He dis - psychiatrist working at Columbia ing a public hearing on December 19, cussed the July 1 closing of all county 2011, to address how the transition is mental health clinics and the successful Page 4 New York State Psychiatric Association • THE BULLETIN Albany Report continued from page 1 As reported in the last issue of The the Advisory Committee, the small State Share Medicaid spending in 2011- in the midst of a tidal wave of transfor - Bulletin , the MRT Behavioral Health work group would have no more than 12, total $596.35 million. Meanwhile, mation brought on by the initiatives of Reform Work Group submitted its final ten members and consist of a member you will recall that the budget also set a the Medicaid Redesign Team. Still, recommendations on October 15, 2011, who is a proponent of the proposal, a Global State Medicaid spending cap of NYSPA is looking to 2012 with a focus the text of which can be found online member impacted by the proposal, a $15.3 billion in 2011-12 and $15.9 bil - on two main priorities: at: http://www.health.ny.gov/ health_ member that represents an impacted lion in 2012-13. Through September, • Hospital Bankruptcy & Physician care/medicaid/redesign/docs/mrt_beha- provider group and others who would Medicaid State spending is $134.9 mil - Liability – Pursue the enactment of vioral_health_reform_recommend.pdf be impacted including state agencies, lion below projections or 1.8 percent, legislation that would require hospi - Work Group on Work Force Flexibility unions and consumers. The Center for while cumulative spending from April tals in New York State to be proac - & Scope Of Practice Health Workforce Studies will serve as through September totaled $7.499 bil - tive with regard to protecting physi - After considering 87 proposals that ran staff to the committee tasked with con - lion compared to estimate of $7.634 cian employees from liability in the the gamut from expanding the scope of vening work groups and preparing billion. Still, pressure on the Medicaid event the hospital goes bankrupt or practice of podiatrists and certified reports. The full text of the budget is increasing as enrollment in becomes insolvent. NYSPA will be nurse anesthetists to establishing certifi - Workforce/Scope of Practice Work Medicaid has grown by approximately working in collaboration with cation for clinical nurse specialists, the Group recommendations can be found 71,000 enrollees since April. MSSNY in 2012 to enact this urgent - work group on Workforce Flexibility online at: http://www.health.ny.gov/ Parity & E&M CPT Codes ly-needed legislation. health_care/medicaid/redesign/docs/wo and Scope of Practice voted in favor of NYSPA is actively monitoring insurers’ • Prescriber Prevails – Support pre - rkforce_flexibility_scope_of_practice_ forwarding 13 recommendations to the compliance with the federal parity regu - scriber prevails in Medicaid man - wg_recommend.pdf Medicaid Redesign Team. MRT member, lations and the directive the State aged care as a result of changes Richard Gottfried, Chair of the Update on Medicaid Redesign Team Insurance Department issued late last enacted in 2011-12 budget regarding Assembly Health Committee abstained, Proposals in 2011-12 Budget: year that reminds insurers that they are psychotropic medications. OMH/OASAS Name Regional BHOS noting he was the Assembly’s represen - required to accept and initiate the pro - Expectations for the enactment of the tative to the MRT and that Assembly- The Department of Health has imple - cessing of all claims submitted by psy - physician collective negotiation bill woman Deborah Glick, Chair of the mented or is in the process of imple - chiatrists including Evaluation and remain high following the Senate’s pas - Assembly Higher Education menting seventy-eight of MRT propos - Management (E/M) Current Procedural sage of the bill before it adjourned this Committee, had expressed concern and als that were approved in the 2011-12 Terminology (CPT) Codes. In regards to past year and NYSPA will continue its opposition to some of the recommen - state budget, the most important of parity, NYSPA has received some com - support of that and MSSNY’s priorities dations. which to psychiatry is proposal #93, plaints from members that insurers are regarding medical liability reform, and The recommendations that are of par - which provides for the establishment of not disclosing the criteria it uses to transparency in insurers’ methodology ticular importance to NYSPA: regional behavioral health organiza - make medical necessity determinations for calculating reimbursement for out- tions (BHOs) that will monitor inpa - even though the federal parity regula - • Remove the requirement that certi - of-network services as many insurers tient fee-for-service behavioral health tions require such disclosure upon the fied nurse practitioners enter into a have begun tying their reimbursement services of Medicaid beneficiaries with request of a provider or patient. In collaborative agreement with a in such instances to a percentage of the serious and persistent mental illness. addition, it has come to NYSPA’s atten - licensed physician. Medicare fee schedule. The Office of Mental Health and the tion that some insurers are differentiat - • Extend to July 1, 2016, the exemp - Office of Alcoholism and Substance ing between E&M codes for medical or Meanwhile, NYSPA will be fighting the tion that programs or services Abuse announced that they have con - surgical services and E&M codes for efforts of nurse practitioners who are operated, regulated, funded or tracted with the following: psychiatric services. One letter a mem - seeking passage of legislation that approved by the Department of would allow them to admit a patient • New York City Region: ber received from an insurer stated, Mental Hygiene, the Office of on a voluntary/involuntary basis and OptumHealth “E&M codes for medical or surgical Children and Family Services, the services are not 'comparable' to E&M perform such functions currently Department of Correctional Services, • Hudson River Region: Community restricted to psychiatrists and other Care Behavioral Health codes for psychiatric services under [the the State Office for the Aging, the Mental Health Parity and Addiction physicians, pursuant to Article 9 of the Department of Health or local gov - • Central Region: Magellan Behavioral Mental Hygiene Law. Health Equity Act]. Given the differentiation in ernment unit or social services dis - services, variations in E&M code reim - Rest assured, there have never been so tricts has from the laws providing for • Western Region: New York Care Coordination Program bursement are clinically appropriate.” many moving parts and balls in the air the licensure of social workers, psy - NYSPA has brought these issues to the on the state and national level. On the chologists and mental health practi - • Long Island: Northshore LIJ/Value Options attention of the Department of State level, the redesign of the Medicaid tioners. Financial Services, the entity formed by program will culminate with the elimi - In Phase I, the above behavioral health • Remove physician supervisory ratio the merger of the Insurance and nation of fee-for-service and growth of organizations will be responsible for of physician assistants. Banking Departments and is forwarding managed care. Nationally, there are sev - the following: concurrent review of complaints received from members to eral forthcoming outcomes that will • Establish an advisory committee to behavioral health inpatient length of the Department’s Consumer Bureau to have a very real impact, including the the State Education Department's stay; reducing behavioral health inpa - Office of Professions that would cre - investigate. Supreme Court’s ruling on the constitu - tient readmission rate; improving rates tionality of the federal healthcare ate a system for evaluating workforce of engagement in outpatient treatment Status of Health Insurance Exchange flexibility proposals including Legislation reform law and the 30 percent cut to post discharge; gathering information physician reimbursement that was changes in scope of practice that The Senate did not return to Albany on clinical conditions of children with scheduled to go into effect January 1, would be based on scientific data before the end of 2011 to take up the a serious emotional disturbance who 2012, under Medicare due to the sus - regarding impact of the proposed bill establishing the governance struc - are covered by Medicaid Managed Care tainable growth rate formula, but was change on cost, quality and access to ture the insurance exchange in New and receiving treatment in an OMH- staved off for two months by last care. York, which the Assembly passed before licensed specialty clinic; and profiling minute Congressional action. While it adjourned. The bill is facing opposi - The proposal to establish an advisory provider performance and testing sys - it’s unclear where the chips will land, tion from several members of the committee to the State Education tems metrics. NYSPA will continue to one thing is certain – the ripple effects Senate Republican conference. Department's Office of Professions monitor the developments of this ini - will transform the healthcare system as Although New York has not passed leg - incorporates a number of the proposals tial phase as preparations for the sec - we know it. I brought to the Workforce Flexibility/ ond phase in 2013 will include estab - islation to establish the insurance Scope of Practice Work Group, includ - lishing “some form of risk-bearing exchange, it has been awarded more [email protected] ing those from the Medical Society of Medicaid managed care” for those with grant money than many other states. To the State of New York and the State serious and persistent mental illness. date, New York has received more than University of New York urging a com - The State is moving full steam ahead $38.7 million with the latest round of --- prehensive study of workforce matters with proposal #89 to establish health funding coming in August through a The New York State beyond the self-aggrandizing proposals homes for high-cost, high need Level One establishment grant for $10.7 of the professional associations on the Medicaid enrollees with two or more million. A lack of action on necessary Psychiatric Association work group. The standing members of chronic conditions or a serious and per - government structure will cause New the advisory committee would include sistent mental illness for which it will York to miss the September 30 and is pleased to announce officials from the Department of receive a 90/10 FMAP. While the December 30 deadlines to apply for fur - Health, Office of Mental Health, Office Department initially expected to imple - ther and more substantial funding. The that Jeffrey Borenstein, of Alcohol and Substance Abuse ment the proposal on a statewide basis State will have two more chances in Services, Department of Labor, State all at once, it has since decided to move 2012 – March 30, 2012 and June 29, M.D., has been University of New York, City University implementation into three phases with 2012. of New York, legislative staff, profes - the first phase scheduled to start on Priorities/Outlook on 2012 Legislative named Editor-in-Chief sional associations representing physi - February 1, 2012 (pending CMS Session cians, nurses and other allied health approval of the State Plan Amendment) The dynamics of the 2012 Legislative of Psychiatric News , the professionals, health work unions, the in the following ten counties: Bronx, Session are already surfacing. The Center for Health Workforce Studies, Kings (Brooklyn), Nassau, Warren, Governor with an approval rating in the official newspaper of the the Paraprofessional Healthcare Washington, Essex, Hamilton, Clinton, stratosphere will face another multi- Institute, and consumer groups. Upon Franklin, Schenectady. billion dollar budget deficit with a American Psychiatric the State Education Department’s To date, the savings achieved from the Legislature that will be up for re-elec - request to review a particular proposal, Association (APA). proposals, which were projected to pro - tion in November. The health care sys - a small work group would be con - duce $2.2 billion in savings for the tem infrastructure in New York will be vened. Drawn from the membership of

New York State Psychiatric Association • THE BULLETIN Page 5 Medicaid Redesign continued from page 1 committee working group. All of the form to the Office of Mental Health interests decimated when they are expressed its belief in a data driven sys - changes in our system are being played PSYCKES Quality Initiative, the goal of drawn into full service medical man - tem and one in which consumers out against the vast array of changes which is to minimize exposure for aged care and have been savaged by should experience more choices of taking place nationally which include those requiring atypical antipsychotics commercial carve-out managed care, accessible services. Recent years have the implementation of the American who are at risk for cardiometabolic syn - which is notorious for “just saying no” seen reimbursement for CDT programs Recovery & Reinvestment Act (ARRA), drome to those medications which put without helping to solve clinical prob - so reduced as to force the closure of and the Patient Protection & them at highest risk. The state’s own lems. Hopefully, nonprofit carve-out many across the state in favor of push - Accountable Care Act (PPACA). formulary is similarly flawed. Also, managed care will provide a more col - ing for the opening of PROS programs. How New York State’s system of public given the limitations on drugs, doses laborative route, one which New York Many clinicians remain skeptical of this health care will look in the future hangs and numbers of pills dispensed, psychi - State may wish to embrace going for - programmatic realignment, believing in the balance based on how well these atrists are forced to expend undue time ward. that for an important cohort of vulnera - state and national changes are imple - on these matters during patient visits. Health Homes, encouraged by the ble persons with SPMI, CDT offered an mented and work together. Needless to The new approach is especially prob - PPACA, will replace Targeted Case important level of care, given its focus say, we all hope for the best, as our pro - lematic when patients are seen in the Management (TCM) over the next cou - on stability and protection, which fessional practices as well as our ability Emergency Department. NYSPA pro - ple of years. They will seek to incorpo - PROS may not offer with its emphasis to provide care for those we serve and vided testimony on this matter to a rate more than 700,000 persons on focused skills training and shorter the care we ourselves receive depend on Hearing held by Assemblyman Richard enrolled in the state Medicaid program stays. They believe that one program it. (Yes, given the dependence of New Gottfried, Chair of the Assembly Health who by virtue of having SPMI and/or should not have been endorsed at the York’s hospitals on Medicaid reimburse - Committee, who shares our perspective multiple chronic medical diseases cost expense of the other and that both ment, the quality of care all New on this issue. The loss of “physician the system disproportionately large might have continued to be viable and Yorkers receive in hospitals depends on prevails” was ill advised, harmful for amounts of money. While New York thus provided consumers with a broad - their Medicaid reimbursement.) At the patients and deserves to be reversed. State will be advantaged by the federal er array of care options. It also would same time, it would not be inappropri - Psychiatrists’ experience with managed government's assumption of 90% of the have been appropriate to collect data ate to remain skeptical that it will come care has traditionally been particularly cost for the first two years, it remains on the impact of the shift, especially on out all right. Some steps taken give rea - difficult. Thus, the news that all New unclear given the reimbursement metrics such as avoidable inpatient son for hope while others do not. York State Medicaid enrollees will be scheme whether there will be adequate readmissions which has correctly been identified as an important focus of What questions should NYSPA be ask - moved into managed care over the next funding to realize the cost saving goals BHOs. Unfortunately, such data was ing and, based on answers received, several years was not good news! of the effort, especially given the limit - never sought. what should we be advocating for or However, we are pleased that the transi - ed funding for the SPMI cohort when against? Concern needs to be raised tion is being phased in over time, pro - contrasted with current funding of the I should like to call attention to a final about the “Tower of Babel” approach to viding an opportunity to create a more TCM program, an approach tailored area of concern having to do with the new Medicaid formulary. Rather collaborative, less adversarial form of specifically for those with SPMI. “scope of practice." Under ordinary cir - than leveraging the state's immense care management. By designating five Ultimately, whether Health Homes and cumstances, changes affecting the purchasing power to realize savings, as regional carve-out Behavioral Health BHOs will work together and align requirement for a “practice agreement” advocated in NYSPA’s 2005 position Organizations (BHOs), which will gath - their goals or trip over each other for nurse practitioners would be paper on the Preferred Drug List, New er data and engage in collaborative remains an open question with serious addressed by the legislature in a bill York State now requires each Medicaid management for the next year or so, the potential consequences for patients and after the adoption of the budget. HMO to create its own formulary. The state and providers will gain informa - providers. However, the MRT Workforce subcom - end result is a capricious process result - tion that should inform decisions when The NYS Office of Mental Health has mittee, going beyond its original charge, ing in a multitude of differing formula - the BHO come under the control of risk sought to refocus the mental health sys - chose to make recommendations deal - ries for psychoactive medications. bearing entities starting in 2013. tem into a person-centered, recovery- ing with this sensitive public health Mental health advocates have seen their Many of these formularies do not con - oriented approach. The agency has also [See Medicaid Redesign on page 7]

Page 6 New York State Psychiatric Association • THE BULLETIN 2011 Contributors to the New York State Psychiatric Political Action Committee, Inc.

As of December 31, 2011 Lewek, William, M.D. Waldbaum, Ruth, M.D. Block, Seymour, H., M.D. Lipton, Brian, M.D. Weisbrot, Deborah, M.D. Bogdonoff, Lisa, M.D. SUSTAINING MEMBER Livingston, Colleen, M.D. Weiss, Andrea, M.D. Bone, Stanley, M.D. ($175.00 or more) Marcus, Eric, Robert, M.D. Weiss, William, M.D. Bragin, Valentin, M.D. Adegbite, Samson, M.D. Marcus, Judith, M.D. Brown, Richard, M.D. Barchas, Jack, M.D. Martin, Glenn, M.D. CONTRIBUTING MEMBER Caccavale, Kenneth, M.D. Bardinelli, Anthony, M.D. Mccarthy, Richard, M.D. ($125.00-$174.00) Cairo, Irene, M.D. Bark, Nigel, M.D. Menolascino, Shelly, M.D. Auchincloss, Elizabeth, M.D. Cancellieri, Carmela, M.D. Becker, Eugene, M.D. Nass, Jack, M.D. Benezra, Joseph, M.D. Clark-Rubin, Lorna, M.D. Berkman, Kathy H., M.D. Neal, Robert, M.D. Bryskin, Lawrence, M.D. Colon, Lillian, M.D. Bernstein, Carol, M.D. Nierenberg, Marvin, M.D. Shenoy, Chitra, M.D. Davidson, Leah, M.D. Bernstein, Jeffrey, P., M.D. Nininger, Jim, M.D. Chun, Kyung, M.D. Desir, Bertholet, M.D. Bindra, Reba, M.D. Nobilski, Mary, M.D. Cournos, Francine, M.D. Dewan, Mantosh, M.D. Brewer, Eric Joseph, M.D. Olympia, Josie, M.D. Dalsimer, Andrew, M.D. Engel, Lenore, M.D. Citrome, Leslie, M.D. Paley, Ann-Marie, M.D. Falk, Katherine, M.D. Fernbach, Rachel, Esq. Cross, C. Deborah, M.D. Panahon, Norma C., M.D. Faretra, Gloria, M.D Firestein, Stephen, M.D. Denea, Russell, M.D. Papilsky, Shirley, M.D. Finger, Mark, M.D. Garson, Paul, M.D. Dorsky, Joshua, M.D. Pardes, Herbert, M.D. Gers, Seymour, M.D. Gerbarg, Patricia, M.D. Dowling, Frank, M.D. Patel, Narendrabhai, M.D. Gift, Thomas, M.D. Golash, Terry, M.D. Drescher, Jack, M.D. Pender, Vivian, M.D. Glassberg, Stephen, M.D. Goldblum, Barbara, M.D. Duvvi, Vikram, M.D. Perlman, Barry, M.D. Hanin, Edward, M.D. Gonzalez, Jose, M.D. Echevarria, Juan-Carlos, M.D. Perry, Paul, M.D. Kaplan, Marvin, A., M.D. Gorman, Kevin, M.D. Einbinder, Eli, M.D. Peyser, Herbert, M.D. Kovasznay, Beatrice, M.D. Gorman, Lauren, M.D. Fein, Sidney, M.D. Pradhan, Pemala, M.D. Kentros, Mary, M.D. Gorzynski, Janusz, M.D. Ferro, Dominic, M.D. Rayport, Stephen, M.D. Marcus, Douglas, M.D. Griffin, Anne, M.D. Finkelstein, Frank, M.D. Rosenthal, Jesse, M.D. Mcintyre, John, M.D. Grinols, Donald, M.D. Flax, James, M.D. Russakoff, L. Mark., M.D. Newton, Jeffrey, M.D. Grossman, Paula, M.D. Fox, Herbert, M.D. Sack, Peter, M.D. Pearl, Alan, M.D. Gudis, Matthew, M.D. Freedman, Jeffrey, M.D. Saeed, Aliya, M.D. Perry, David Arnold, M.D. Halligan-Mccaleb, Erin, M.D. Gallo, Richard, Esq. Salkin, Paul, M.D. Rosenthal, William, M.D. Halpern, Abraham, M.D. Gennaro, Karen, M.D. Samberg, Eslee, M.D. Rowe, Timothy, M.D. Hartmann, Edward S., M.D. Ginsberg, David, M.D. Satloff, Aaron, M.D. Rydzinski, Joyce, M.D. Herman, Edward, M.D. Gold, Risa, M.D. Schongalla, Ann W., M.D. Sadock, Virginia, M.D. Ihlenfeld, Charles, M.D. Gordon, Edward, M.D. Schwartz, Michael, M.D. Salamon, Itamar Ingram, Douglas, M.D. Gosline, Ernest, M.D. Seiden, Leslie, M.D. Saran, Brij, M.D. Kahaner, Kenneth, M.D. Green, Norma, M.D. Seligson, Jose, L., M.D. Shapiro, Gabrielle, M.D. Kaplan, Joel, M.D. Grosch, William, M.D. Shinbach, Kent, M.D. Sodaro, Edward, M.D. Kibel, Howard, M.D. Hertz, Stanley, M.D. Shukla, Sashi, M.D. Smith, Robert, M.D. Klopott, Zvi, M.D. Heyman, Arlene, M.D. Sickinger, Claudia, M.D. Stephens, Edward, M.D. Komareth, Vijayakumar, M.D. Hirschowitz, Jack, M.D. Stein, Peter, M.D. Wein, Steven, M.D. Krakower, Leon, M.D. Horwitz, Gary, M.D. Stein, Seth P., Esq. Ladopoulos, Paul C., M.D. Inwood, David, M.D. Stempler, Allan, Ivan, M.D. GENERAL MEMBER Lindy, David, Charles, M.D. Ipsen, Carol Anne, M.D. Stopek, Susan E., M.D. ($75.00-$124.00) Luparello, Thomas, M.D. Joseph, Brian, S., M.D. Sullivan, Ann-Marie, M.D. Allegra, Christopher, M.D. Maetzener, Christian, M.D. Kenin, Michael, M.D. Tarle, Marc, M.D. Almeleh, Jack, M.D. Mannucci, Mannuccio, M.D. Knobler, Joanna, M.D. Thakkar, Vatsal, M.D. Amyot, Edmond, M.D. Mattson, Marlin, M.D. Knox, Thomas, M.D. Underwood, Jack, M.D. Ashley, Kenneth, M.D. Marantz, Robert, M.D. Kroplick, Lois, M.D. Van Aken, Thomas, M.D. Ashton, Adam, M.D. Lapidus, Michael M.D. Varon, Darvin, M.D. Auchincloss, Sarah, M.D. Laufer, Ludwig, M.D. Viswanathan, Ramaswamy, M.D. Benson, Rs, M.D.

Medicaid Redesign continued from page 6 matter. As a consequence, it is likely to This piece can only begin to focus detract from a meaningful relation with to their patients. If the system does not be included as part of the 2012 attention on the tectonic areas of trans - those treated. Thus, valuable profes - permit improved practice patterns that Executive Budget. NYSPA along with formation that the health and mental sional time is squandered and job satis - allow for better therapeutic relations, organized medicine believes the recom - health systems in New York State and faction diminished. Perhaps if we are younger colleagues, often graduating mendation to drop the requirement for the nation are passing through. NYSPA lucky, and if the Rubik’s Cube of system with significant debt, may choose to a “practice agreement” presents a public will continue to advocate, along with change is properly solved, we may see look elsewhere when making their health concern. It would allow nurse other groups, to prevent or minimize the improvements. It is critical that career choices which would represent a practitioners a comparable scope of harm to the persons we serve and to attention be paid to the “professional great loss to our field and the public practice to primary care physicians and our profession. To date, the state, man - fulfillment” of psychiatrists choosing to mental health system. I specialists, including psychiatrists, with - aged care and others have disregarded work in the public sector. Too often Dr. Perlman is the Director, Dept. of out the necessary training gained the burden placed on physicians, these psychiatrists are forced by the cal - Psychiatry, Saint Joseph’s Medical Center, through residency. For this reason, including psychiatrists, and other culus of cost to grind out patients at a Yonkers, N.Y. and NYSPA Legislative NYSPA shall work to oppose such providers when creating regulations rate of three or more per hour leaving Chair and Past President. change. and requirements of participation that little opportunity to relate meaningfully

New York State Psychiatric Association • THE BULLETIN Page 7 Seeking a dynamic and dedicated Chief of Psychiatry to join our progressive and inno - vative health system in Rochester, NY Rochester General Health System (RGHS) is seeking a dynamic Board Certified Psychiatrist with a commitment to excellence for our Chief of Psychiatry opportunity. This outstanding candidate should have at least 5-7 years of experience in the field of Psychiatry, demonstrated clinical leadership and admin - istrative experience. Key components of this position include the participation and active support of the overall Rochester General Health System strategic plan in collaboration with the Chief of Psychiatry; the development of a fully integrated behavioral health program throughout Rochester General Health System; support and cultivation of relationships among the behavioral health services and other services within the System; and the collaboration with other departments in the development of joint services to enhance the mission and vision of Rochester General Health System. With nine locations across the area, including two of the area's best mental health centers, Genesee Mental Health Center and Rochester Mental Health Center, RGHS’ Behavioral Health Network (BHN) has over 40 years of experience. The Behavioral Health Network provides a comprehensive system of clinical mental health services, readily-accessible, culturally-sensitive services uniquely matched to the individual needs of each patient and their family, convenient access to mental health outpatient services with locations throughout the greater Rochester area, and an unwavering commitment to serve those in our community who have emotional needs Caring for the whole person is our primary focus. In so doing, we are able to provide integrated Mental Health Services throughout the entire BHN System. With our multidisciplinary team that includes psychiatrists, nurses, certified alcohol and substance abuse counselors, other counselors, social workers, psy - chologists and case managers; we provide the necessary support and service to meet your daily needs. To learn more about the Behavior Health Network visit www.rochestergeneral.org/behavioral-health-network. Highlights of Rochester General Health System A top 100 Integrated Health Network and the 3rd largest employer in the region encompassing seven affiliates including: • Rochester General Hospital, a 528-bed tertiary care facility treating more patients than any other hospital in the region • Newark-Wayne Community Hospital, a Joint Commission accredited, 120-bed a cute care community hospital & 180 bed hospital-based nursing facility • 1st in New York State for Overall Medical Care, according to the latest report from CareChex®, a division of The Delta Group • Only Thomson Reuters Top 100 Cardiac Hospital in the region • Nurse Magnet Designation • National Top 20 Robotic Surgery Center • New York State Designated Stroke Center – Joint Commission accreditation • World class medical and dental staff with exceptional specialist support • Large primary care referral base • Recognized leader in quality improvement & commitment to deliver unparalleled patient care inclusive of an Institute for Patient Safety and Clinical Excellence as a means to develop a comprehensive program of patient safety education initiatives, performance improvement processes, and prevention techniques. • Cutting edge EMR system • State-of-the-art Emergency Department with average annual patient volume of 110,000 • Innovative affiliations/strategic partnerships with Rochester Institute of Technology, Cleveland Clinic,Roswell Park Cancer Institute and Carestream Health. • Our Centers of Excellence include: Rochester Heart Institute, Lipson Cancer Center, Orthopaedics,Women’s Health, Primary Care, Surgical Services, and Behavioral Health • For more information on our healthcare system visit: www.rochestergeneral.org Highlights of Rochester, NY Located on the shores of Lake Ontario and proximity to the Finger Lakes Region, Rochester provides residents with an exceptional quality of life. We have the arts, sports, and culture of a big city and the comfort and easy commutes of a small town. Rochester’s unsurpassed private and public educational institutions include 15 of the country’s finest colleges and universities, and public high schools ranked among the 100 Best High Schools in America. Rochester is ranked 4th on Forbes mag - azine’s list of most affordable cities and 3rd best metropolitan region in the country for raising a family. If you are looking to join a world class Medical and Dental team please contact: [email protected] or [email protected] in the Office of Physician Services or visit our website: www.rochestergeneral.org/physicianrecruitment

Notice Of Good Faith Estimate Of Non-Deductibility Of NYSPA 2012 Dues

The Omnibus Budget Reconciliation Act of 1993 included certain provisions denying tax deductibility for the portion of dues paid to 501(c)(6) professional organizations that is spent on influenc - ing state or federal legislation. The law requires NYSPA to provide its members with a good-faith estimate of the portion of their dues which is attributable to lobbying and therefore, is non-deductible for federal income tax purposes.

For 2012 dues, NYSPA has estimated that 33 1/3% of NYSPA/Area II dues are attributable to lobbying and cannot be deducted. The schedule below sets forth the calculation of the deductible and non-deductible portion assuming payment in full. If only a partial payment was made, then 33 1/3% of the amount paid is non- n o i deductible. t a i c o s s A

n c i

Membership Category 2012 Dues Deductible Non- o i r t t a a i Deductible i c h o c s y s General Member/Fellow 165.00 110.00 55.00 s P A

c n i a r t

Member in Training 15.00 10.00 5.00 c i a 0 r i a 3 e h z 5 c a l Life Member/Life Fellow (1-5) 110.00 73.00 37.00 m y 1 s P 1 A

P y -

t Y

i l e

Life Member/Life Fellow (6-10) 55.00 36.00 19.00 i t N c C a

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o a n I 2 I Y e

Please note that this notification only applies to NYSPA/Area II G

a d e w t r e 0 i e a dues. It does not apply to APA dues or to district branch dues. If r 0 u N A 4 S you have any questions, please do not hesitate to contact the G NYSPA Central Office. Receive the E-Bulletin–Email NYSPA at [email protected] Read The Bulletin online at http://www.nyspsych.org/bulletin