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 Update on Advocacy

      As you know, this has been a very active year for pediatric advocacy across many issues and across Federal and State Priorities.  Everything we work on has the potential to impact the way you practice pediatrics.  Some initiatives can have significant positive impacts on children and families and on pediatrics, others can have very deep and serious negative impacts on pediatrics and on the health and well-being of the children and families we serve.  The following is a brief outline of the many issues we have been working on with your help since late winter of 2017. Nothing on this list has been positively resolved as of this writing.
Federal Advocacy:
      We will continue to ask Chapter members to call their Congressional Representatives and our Senators at various times in the next several months to advocate for:
  • CHIP: The Child Health Insurance Program
  • DACA: The 800,000 young Dreamers in all of our communities
  • ACA: To Maintain the Protections of the Affordable Care Act
  • SNAP/WIC: To Maintain the budget supports for vital nutrition programs
  • Home Visiting Programs: To maintain budget support for key home visiting programs, like Nurse Family Partnership
  • Teen Pregnancy Prevention Funding: Restoration
  • Environmental Health: (EPA cuts)
  • CMS No cuts to Medicaid & DSH: payment issue resolution
State Advocacy & Policy:
  • Participation in Medicaid Reform/VBP Work Groups
  • First 1,000 Days Initiative: Advocating for Bright Futures Medical Home for All Children
  • State Support for NYS DACA kids
  • State Support for CHIP & Medicaid to address federal challenges
  • Funding to Address Food Security in New York
  • Environmental Issues: chemicals in children’s products, tobacco, fracking, water, lead
  • Children’s Mental Health in Primary Care
  • State Support for Addressing Increasing Children and Poverty…Impacts on Health & Well-being: Despite recent reductions in poverty as per Census Report, children remain the poorest of the poor.
  • New Initiatives in Telehealth
  • New State Initiatives addressing old and burdensome regulations: an opportunity to address Standing Orders for Healthy Newborns
  • Advanced Primary Care in Pediatrics/Value Based Payment Systems Implementation in Commercial Insurance and in Medicaid
  • Practice Transformation at all levels
And our usual state based advocacy during the program and budget discussions:
  • Home Visiting/Nurse Family Partnerships
  • Healthy Steps model proliferation
  • ROR universally available
  • Developmental and social emotional screening and referral supports
  • Care management/coordination support
We remain involved in multiple work groups and partnerships to assure that the needs of children are part of all reform discussions and state initiatives.
When you get an Advocacy Alert, please respond. Your voice is the voice of the children of New York.
If you want to become more active or more involved in State or Federal Advocacy, please contact me directly.
Elie Ward, MSW
Director of Policy, Advocacy & External Relations
NYS AAP, A Coalition of Chapters 1, 2 & 3

Ordering/Prescribing/Referring (OPR) Providers Must Revalidate for Claims to be Paid

Federal regulation requires State Medicaid agencies to revalidate the enrollment of all providers every five years.  For many providers Medicaid payment is contingent on the ordering/prescribing/referring (OPR) provider also revalidating their enrollment in Medicaid.  OPR providers who do not comply with the revalidation requirement will be terminated from the Medicaid Program.

The NYS Department of Health has determined that many providers are at risk for not being paid for their services because the OPR provider has not complied with the revalidation requirement.  Because this has the potential to result in significant non-payable claims for you/your facility, we urge you to reach out and encourage your OPR providers to revalidate their enrollment.  Please remember to confirm that your OPR provider is enrolled before rendering service at:

  • The Claim Adjustment Reason Code for non-enrolled OPR provider on your 835 remittance will be:  B7 – This Provider was Not Certified/Eligible to be Paid For this Procedure/Service on this Date of Service.
  • If performing a claim status look for Claim Status Code 91 with Entity Code 1P.

The required revalidation form and instructions are available at  The completed form must be mailed, with all required documentation and fee (if required), to the address provided on page 2 of the form.  Questions should be addressed to the eMedNY Call Center at 800-343-9000, Option 2.

The NYC Department of Health and Mental Hygiene is conducting a large-scale recruitment for school physicians to work at NYC’s public schools.  The candidates being sought should be licensed physicians (specifically pediatricians, family medicine doctors, adolescent medicine doctors, or preventive medicine doctors) who also have a strong public health/population health background (ideally an MPH in addition to MD), and who would like a rewarding opportunity with flexible hours.  Details on available positions:

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