Welcome to your daily briefing on healthcare developments in New York. Today we're covering 5 key stories including updates on new york healthcare headlines, background & context. Let's dive in.
2 stories
The state has released a dataset mapping Article 28 hospitals and hospital extension clinics from the Health Facilities Information System, with plans to add nursing homes, diagnostic centers, home health agencies, hospices, and adult care facilities later.
Healthcare professionals can track facility locations across New York to inform referrals, network planning, and service gap analysis.
The state has released location data for Article 28 hospitals and hospital extension clinics through its Health Facilities Information System (HFIS), with plans to add nursing homes, diagnostic treatment centers, home health agencies, and hospices in future updates.
Healthcare professionals in NY can use this centralized facility location data for network planning, referral coordination, and understanding the current geographic distribution of hospital services across the state.
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3 stories
Across most payors, the top-five denial reasons account for over 80% of prior-auth rejections: missing clinical documentation, wrong CPT/HCPCS code, service not in benefit plan, step-therapy not completed, and ordering provider not on the patient's plan. The same five repeat across plans because they are the easiest to deny on automation.
Practices that build a five-line pre-submission checklist around these reasons typically cut prior-auth denials by 40-60% within a quarter. The fix is process, not appeals capacity.
A vendor is a business associate if they create, receive, maintain, or transmit PHI on behalf of the covered entity. They are NOT a business associate just because they happen to be in a building with PHI or could conceivably access it. The functional test matters, not the proximity test.
Forcing BAA execution on vendors who do not meet the functional test creates contractual bloat and weakens the negotiating position with vendors who actually do. Failing to execute BAAs with true business associates exposes the covered entity to OCR enforcement.
Covered entities must annually recertify their 340B eligibility through HRSA. Missing the recertification window pushes the entity to inactive status, which means immediate loss of 340B pricing and potentially diversion violations on previously dispensed drugs. Reinstatement requires a new application.
The discount value of 340B pricing for a covered entity often exceeds six figures annually. Letting the recertification lapse for paperwork reasons is one of the most expensive administrative errors in the regulation.
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