I-STOP

The state Health Department’s Internet System for Tracking Over-Prescribing, or I-STOP, went into effect in August 2013 and requires prescribers of Schedule II, III and IV controlled substances—such as Adderall, Oxycodone, Ambien and Valium— to consult an online prescription monitoring program that provides practitioners with direct, secure access to view dispensed controlled substance abuse histories for their patients. This allows medical professionals to detect and prevent abuse or non-medical use of prescription drugs. Doctors can see all controlled substances dispensed in the state and reported by a pharmacy or dispenser for the previous six months. The program also aims to identify and stop “doctor shopping,” which occurs when a patient obtains controlled substances from multiple healthcare practitioners without the prescribers’ knowledge of the other prescriptions. State officials said there were more than 89,000 heroin and prescription opioid treatment admissions in 2013, up from 64,000 in 2004. In addition, Gov. Andrew Cuomo signed new legislation last June that grants the Department of Health’s Bureau of Narcotic Enforcement expanded access to criminal histories to aid investigations of prescribers and dispensers believed to be engaging in illegal prescriptions. The law also increases the penalties for the criminal sale of a controlled substance by a pharmacist or practitioner by making the crime a class C felony.

Medical Marijuana

In June New York became the 23rd state to legalize medical marijuana, although it is one of several states to ban the use in smokable form. Patients may use a vaporizer or an oil base. New York State patients are eligible if they suffer from HIV or AIDS, cancer, amyotrophic lateral sclerosis, Parkinson’s disease, multiple sclerosis, spinal cord nerve damage, epilepsy, inflammatory bowel disease, neuropathies and Huntington’s disease. Medical marijuana can also be prescribed to patients with the following symptoms: cachexia or wasting syndrome, severe or chronic pain, severe nausea and severe or persistent muscle spasms. Regulations allow a maximum of a 30-day supply of medical marijuana only, and minors are permitted to use marijuana-based oils under the supervision of an authorized adult only. The state is now charged with implementing the program, which is not expected to be up and running until 2016. New York State must still choose and regulate the 20 venders that will be allowed to sell and grow medical marijuana. The state will also be carefully monitoring for any abuse of the system, and has the authority to shut the program down if it proves problematic. The state recently requested federal permission to import out-of-state medical marijuana for children and young adults with epilepsy who need immediate relief.

Hydrofracking

New York has had a moratorium on high-volume hydraulic fracturing, the controversial method for drilling natural gas, for the past six years while the state Department of Environmental Conservation conducts a long-running review of hydrofracking’s potential health effects. That review will ultimately determine whether hydrofracking will be allowed in the state. The DEC’s review cannot be completed without a separate Department of Health analysis, which was started in September 2012. Gov. Andrew Cuomo inherited the health review when he took office in 2011. Then–Health Commissioner Nirav Shah said in 2013 that the review would only take weeks, but more than a year later the review still remains open and Shah has since stepped down from his position. Howard Zucker, the acting state health commissioner, has largely remained silent on the review’s progress. Fracking has become a highly politicized issue, and Cuomo is now known to have changed his scheduling habits—announcing appearances at the last minute and often having no public schedule—in an effort to avoid anti-fracking activists showing up at his events. Cuomo said in the recent gubernatorial debate that the review is now due to be completed by the end of the year— presumably after Election Day.

Medicaid Waiver

Last April Gov. Andrew Cuomo announced that New York had reached an agreement with the federal government for a Medicaid waiver that will allow the state to reinvest $8 billion in federal savings generated by the state’s Medicaid Redesign Team’s reforms. The state first applied for the funding in 2012 after the Medicaid Redesign Team implemented a series of reforms estimated to save the federal government $17.1 billion over five years. Under the agreement $500 million would be allotted for short-term assistance to keep hospitals and other providers operating while reforms take place; $6.42 billion for “Delivery System Reform Incentive Payments” (DSRIP), which aim to reduce avoidable hospital use through delivery system reform; and the remaining $1.08 billion would be allocated for other Medicaid Redesign purposes—such as investments in long-term care, workforce and enhanced health services. The funding does not provide direct aid to hospitals but goes toward broader reform of the state’s healthcare system. The DSRIP program specifically aims to achieve a 25 percent reduction in avoidable hospital stays over five years.