With January came the return of the legislature back to Albany. Then came Governor Hochul’s State of the State address, followed by her executive budget proposal. These events got the 2023 state legislative session into full swing. The Governor held her State of the State address on January 10th followed by her budget proposal in early February. With all of the challenges still being faced by hospitals, IHA is disappointed by the lack of emphasis on healthcare by the Governor. This, however, allows us to help frame the debate with the Legislature when it comes to the needs of hospitals in Upstate New York. Something we had great success with at the end of last year, when we participated in an Upstate Assembly Delegation press conference in December. This press conference allowed IHA to explain the staffing and financial challenges that need to be addressed by policymakers. IHA has continued it advocacy with the legislature, the Department of Health (DOH) and its new Commissioner, the Division of the Budget (DOB) and its new Director, and the Governor’s office to ensure that they hear and understand the need for support to be delivered.
Political Landscape
As Governor Hochul gets her first term under way as an elected governor, political developments are getting a lot of attention from Albany insiders. Just days before Christmas the legislature called a special session to enact a Legislative pay raise which the governor then approved. This is something that happens occasionally and is subject to a good deal of political posturing and negotiation. It seems however that the Governor approved of the salary increase without gaining a political advantage. Next, the Senate voted against her nominee to be the next Chief Judge of the Court of Appeals Justice Hector LaSalle. The Senate Judiciary Committee seemingly refused to move the nominee forward until there was a court challenge brought by the ranking minority member of the Judiciary Committee. With a court hearing on the case imminent the Judiciary Committee reversed course, brought the nomination to the floor for a vote, ultimately voting the nomination down. Despite these actions meant to neutralize the court case, the Court went on to decide that the Senate actions were not constitutional. This further scrambled the political dynamics in Albany and appears to have spilled over into the budget process.
Budget
The 2023-2024 State Fiscal Year began on April 1, without the Governor and Legislature having agreed upon a final budget. State leaders did however pass a temporary budget extender bill to authorize State spending until April 10 as negotiations continue. On that score, negotiations do not appear to be extensive being primarily focused on bail reform and housing issues. Not much focus has been placed on the health budget.
IHA’s Budget Advocacy
IHA held a series of meetings joined by its Executive Committee to advocate for its members’ needs. The advocacy team along with several member CEOs met with legislative leaders including Assembly Health Chair, Amy Paulin, the office of Senate leader Andrea Stewart-Cousins, and Senate Health Chair, Gustavo Rivera. IHA explained the forever changed cost structures faced by its members, the need for increased state support, direct funding for Upstate hospitals through the Directed Payment Template Program and a 25% increase in the Medicaid rate. In addition, IHA continues to push for funding of innovative staffing solutions like Integrated community paramedicine, early college in the high school healthcare profession pipeline programs, and dedicated recruitment and retention funding for Upstate Hospitals. IHA’s advocacy will not stop as state leaders continue their budget negotiations to ensure that Upstate hospitals receives the fair support they desperately need.
Budget highlights include:
- The Governor’s proposed 5% Medicaid increase, meant to offset lost revenue from the repeal of 340B program
- The Legislature has proposed a 10% increase.
- The Assembly has proposed an additional $750 M in supportive funding for hospitals. While the Senate has proposed $1B in such finding.
- $1 billion for a fifth round of health care transformation funding, $500 million for capital projects and $500 million for improved IT capacity
- VAPAP program modifications
- Rural Emergency Hospital Designation
- Staffing agency legislation
Legislative and Regulatory Developments
Legislation
As legislation continues to be introduced we will distribute memos regarding our position. Thus far we are in support of a number of bills including;
• A.3076-A/S.447-C to allow for 1/3 of certain clinical training to be completed via simulations. This bill unanimously passed both houses of the Legislature.
• S.2923 to develop initiatives to improve the capacity to prepare future generations of entry and advanced level nurses.
• A.3361/S.3445 to provide payments to rural hospitals designated as critical access hospitals (CAH).
Regulations
DOH is working to promulgate regulations for the June 23 effective date of the now statutorily required Health Equity Impact Assessments (HEIA) as part of the Certificate of Need (CON) process. DOH has presented to the IHA board of directors on this issue as well as to the Public Health and Health Planning Council’s Codes Committee.
The draft regulations have yet to be officially published for public comment. IHA has shared that it is supportive of the issue of ensuring health equity, but that in implementing this new requirement care be taken so as not to unintentionally disrupt the already extensive and thorough CON review.
Staffing Committees
On March 1, DOH published for comment its proposed rule for Clinical Staffing in General Hospitals following their presentation at the February 2023 meeting of the Public Health and Health Planning Council. These proposed regulations implement amendments to Public Health Law § 2805-t that were in enacted in 2021 and which IHA opposed. As a refresher, the 2021 law require hospitals to establish a clinical staffing committee, submit a clinical staffing plan developed by the committee and implement the adopted plan on January 1, 2023.
The proposed regulations supplement the law a few by requiring a minimum of one registered nurse to care for every two patients needing intensive or critical care. This requirement would be based on assessment of patient acuity and not be limited to the patients located in the ICU or CCU.
In addition, complaints regarding clinical staffing must be made first to a hospital’s clinical staffing committee. If a complaint is not resolved within 90 days of submission, the complaint may be submitted to DOH.