Advocacy Update – Summer 2023 Newsletter

After a late budget and whirlwind legislative session, work at the Capitol in Albany has wound down for the summer. This year, Legislators continued their two-year streak of passing late budgets; the FY-2024 budget was not finalized until May 3rd. Governor Kathy Hochul has made it clear that an on-time budget is not among her top priorities. She would rather the budget be “done right” rather than on-time.

Several healthcare workforce policies that were introduced in her budget proposal and which IHA strongly advocated for did not make into the final budget due to lawmakers’ aversion to policy-ridden budgets, you can read more about these policies in our legislative session section below.

Shortly after the budget was passed, IHA had a productive May Annual meeting in Cooperstown where we were able to gather many of our CEOs. Our CEOs were joined by Senate Health Chair Gustavo Rivera and Assemblyman John McDonald. These two key legislators shared their thoughts about the legislative session and their priorities. Likewise, they spent considerable time listening about the most pressing issues that our membership faces.

Political Landscape

Although this is Governor Hochul’s second year as the State’s executive negotiating the budget and legislative session, it is her first year as the elected Governor. The leadership styles between Hochul and previous office holders are markedly different. Negotiations went at a much slower pace, communications about the status of agreements were hard to come by. Moreover, it was difficult to get a read on the Governor’s priorities and how they maybe shifting. This, coupled with a large class of freshman legislators made negotiations incredibly unpredictable with much intraparty turmoil.

FY-2024 Budget

After Governor Hochul announced her priority last year to grow the healthcare workforce by 20% in 5 years, IHA was disappointed with the lack of attention paid to healthcare in the Governor’s budget address as well as in the final budget. We strenuously advocated to have the state provide more resources directly to Upstate hospitals to bolster the workforce and assist with the financial crises.

The final enacted budget included:

  • Medicaid rate increases were included for hospital inpatient services at 7.5% and outpatient services at 6.5%. Rates were increased to 6.5% for nursing homes with the intent to increase by 7.5% pending Medicaid approval.
  • Restores $500 million of discretionary funding for financially distressed hospitals
  • $990 million in capital funding to establish a new Statewide Health Care Facility Transformation Program V.
  • Rural Emergency Hospital Authorization
  • Contingent Staffing Agency Registration and Reporting
  • Minimum wage increases
  • Funding Nurses Across New York and Doctors Across New York.
  • $10 million for NYS Workforce Innovation Center

Looking forward to the coming State fiscal years, budget gaps are expected to reach a combined $36 billion over the next three years, $15 billion higher than initially anticipated.

The state Division of Budget recently released its revised financial assessment of New York’s future budget years, finding a combination of slower revenue from taxes and increased spending coupled with a decrease in federal aid are the contributing factors for projected budget gaps.

With respect to other fiscal matters the Healthcare Worker bonus program made headlines in mid-June for costing quite a bit more than was initially expected. The State previously expected Federal matching funds of roughly $1.3 billion for the bonus payments made to eligible healthcare workers. Based on CMS feedback, the Financial Plan has been revised to reflect the State paying the entire cost of these bonus payments. A disappointing development.

2023 Legislative Session

There were a number of workforce related bills that IHA worked tirelessly on during this session. Key players on these issues include Assembly Health Chair Amy Paulin, Senate Health Chair Gustavo Rivera, Senators May and Stavisky and Assemblywoman Fahy. We thank them for their efforts and willingness to fight for the interests of upstate and rural hospitals. These bills are intended to fill the gap left by the expiration of Executive Order 4, which provided proven workforce flexibilities during the COVID-19 pandemic.

• Temporary Practice Authorization (A.6697-B / S.7492-B) Fahy/Stavisky

  • Would temporarily authorize certain licensed, out-of-state nurses and physicians to practice in New York state upon endorsement by an employer and submission of an application for New York state licensure
  • Significantly narrowed over IHA objections
  • Signed into law

• Community Paramedicine (A.6683-B / S.6749-B) Paulin / Rivera

  • Would authorize mobile integrated and community paramedicine programs operating under the E.O. 4 authority to continue operating for two additional years
  • Signed into law

• Telehealth Reciprocal (A.7447-A / S.7432-A) Paulin / May

  • Authorizes physicians licensed in another state or territory of the United States to practice time-limited follow-up care via telehealth in New York state pursuant to a reciprocal agreement; requires annual authorization.
  • Not passed by either house

Other bills of interest include:

• Wrongful Death (A.6698 / S.6636) Weinstein/Hoylman-Sigal

  • Would expand New York’s wrongful death statute to allow for uncapped, non-economic damages
  • Vetoed last session
  • Slightly revised to address concern in veto
  • Passed by both houses

• Safety Net Coalition (A.6785 / S.5810) Walker/Rivera/Paulin

  • Sets reimbursement rates for essential safety net hospitals at no less than regional average commercial rates for health care services provided by all hospitals in the same geographic region
  • Conversation continuing

Certificate of Need (CON) Health Equity Impact Assessment (HEIA)The new law requiring a HEIA as part of certain CON applications became effective on June 22. Companion regulations were approved and effective as of the last week of June.
IHA submitted comments raising concerns about the added financial burden that the regulation would add to hospitals, and the probability of unintended consequences of the process. The committee promised to take a closer look at the closure review process to ensure no punitive actions would be taken towards a hospital seeking closure.

As the summer continues to unfold, IHA has already begun its advocacy for the coming budget and next legislative session. The center-piece of our advocacy with continue to be workforce and financial relief for our membership.