Although the legislature has not been active in Albany since its extraordinary session in July, IHA has been busy at work this summer. The Health Care and Mental Hygiene Worker Bonus (HWB) program was launched, comments on the CMS CAH mileage proposed rule were solicited and submitted, and primary elections were held. Upstate hospitals continue to face unprecedented staffing challenges and critical levels of financial distress, threatening their ability to provide care. In the past several months, IHA has been speaking with agencies, collecting budget priorities, and speaking up for our hospitals who can no longer wait for the State to release financial relief that was promised in the current budget, while readying our legislative agenda for the upcoming 2023 legislative session and budget season.
IHA is poised to continue voicing the needs of Upstate healthcare to State decision makers, and working with our members to create a stronger and more sustainable future for our hospitals and the patients they serve.
Health Care Worker Bonus (HWB)
In late August DOH began to communicate details regarding the highly anticipated Health Care Worker Bonus program. After much urging by IHA, DOH agree to hold “townhall” webinars and answer submitted questions via an FAQ page on their website.
The program had several notable flaws that IHA flagged to DOH, including the hasty deadline, exclusion of titles, and general lack of consideration for the cumbersome obligations it laid onto hospitals.
IHA voiced concerns over the short submission timeframe and the lack of necessary clarity that was making the claim process even more arduous and chaotic for overburdened hospitals. DOH maintained the original deadline, however they agreed to allow submission of vesting period 1 claims during vesting period 2.
IHA has not stopped highlighting for DOH the inequity of omitting from bonus eligibility many critically important jobs titles, such as security personnel who are frequently patient facing, and bravely worked through the height of the pandemic. The burden of explaining the ineligibility to employees was put onto the shoulders of the hospitals, damaging employee relations and creating discontent within their workforces.
Despite “townhall” meetings, questions submitted to DOH, and the FAQ sheet being updated, many unanswered questions remain. Hospital administrations are being forced to find hours in the day to sort out the program, and are being met with little to no meaningful guidance.
The administrative and financial burden this program has forced onto hospitals is unacceptable. The precious hospital resources that are being diverted to administer the bonus program present new and unplanned for burdens. IHA will continue to push the Governor to streamline the process, releasing responsibility and time-consuming duties from hospitals, as well as implement clearer guidance and open the bonus eligibility up to more titles.
IHA is pleased to deliver some good news it was able to achieve related to the bonus program. IHA raised concerns early on about the tax burdens that come with the Health Care Worker Bonus. Our advocacy led to the promise by DOH that hospitals are not responsible for tax remittance stemming from the bonus. This is crucial, as our member hospitals are already dealing with increase financial stressors and cannot afford any other unanticipated costs. IHA continues to raise this issue to ensure that DOH provides a clear and fair reimbursement process that does not further disrupt hospitals.
CAH Comments
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule in July to update the conditions of participation (CoPs) for critical access hospitals (CAHs). The intention of this rule making is to define the CAH distance measuring criteria in a way that comports with the more favorable pre-2015 definition. In particular, the definition would specify that a primary road of travel for determining the driving distance of a CAH and its proximity to other providers as a numbered Federal highway, including interstates, intrastates, expressways or any other numbered Federal highway; or a numbered state highway with two or more lanes each way.
CMS solicited comments to which IHA submitted a letter expressing our view that the proposed rule needs to be taken a step further, ensuring that primary roads are more clearly defined as federal or state numbered highways. IHA asserted that in no instance should such a highway have fewer than two lanes in each direction, and the highways should have limited or controlled access so as not to impede the travel of emergency vehicles.
It is a priority that mileage criteria should exclude or limit roads on which non-motorized vehicles, livestock or agriculture equipment travels. This is essential for rural healthcare institutions that are surrounded by farm lands that often have severely impeded traffic due to the factors aforementioned.
IHA also requested that the status of existing CAHs are grandfathered so as to safeguard the continued long-term operations of these essential safety-net providers in rural communities.
IHA conveyed to CMS that they must be conscientious of decisions that will affect the status of existing CAHs, as it could be detrimental to their survival. We reiterated the critical role that CAHs play and services they provide in their communities, that are essential to remote and isolated populations with no other sources of care. The conditions of participation for CAHs must be carefully considered and emphasis must be placed on the preserving the services they provide.
Meetings with Upstate Delegations, DOH, & DOB
IHA has continued its regular meetings with DOH, DOB and Upstate legislators to frame the issues and reiterate the immediate need for funding to flow to Upstate hospitals.
We presented to them the financial data collected from our membership that illustrates the precarious financial position that Upstate hospitals are facing, and how increased costs stemming from price gouging by staffing agencies has significantly contributed to the issue. We emphasized the need for immediate action by explaining how, for example, days cash on hand levels will rapidly diminish without intervention.
We also discussed potential legislative avenues to relieve staffing pressures such as altered licensure requirements, simulation training, and a potential to increase visibility into the operations of staffing agencies.
When meeting with DOB and DOH we raised the issue of the wait for a directed payment template that has yet to be seen. Their response was that it is “on it’s way” which we have heard several times over the past year.
We will continue to amplify these conversations in order to ensure that our hospitals get the critical funding that they sorely need.
Budget & Legislative Priorities
2023 starts a new two-year legislative cycle. We will continue to voice our position on legislation of interest via memos to the Governor.
There are items that remain from last year’s FY 2023 budget that have not been executed thus far. We have asked that they be distributed as soon as possible. They include;
– Release of SFY 2023 Funding for Hospitals (Safety Net, Capital, Distressed Hospitals)
– Directed Payment Template SFY 2022 Balance, SFY 2023 timeline
– Financially Distressed Nursing Home Funding
– Status of DOH Workforce Office
We are also requesting that the Health Care Worker Bonus be altered to expand eligible titles and add flexibilities.
Our FY 2023-24 priorities include;
– Medicaid Trend Factor increase near-term and long-term solution
– Continued Directed Payment Template funding targeted to Upstate Hospitals, CAHs, Sole Community Hospitals and a reasonable threshold of combined public payers
– Permanent Workforce Recruitment and Retention Fund for Hospitals to access
– 1115 Waiver WIO Funding
– Take a Look Program
The funds we are asking for are essential to the survival of Upstate hospitals. We will continue to push DOB, the Governor, and the legislature to invest in the future of healthcare and warn them of the calamitous outcomes that will occur if nothing is done.
Survey response & Financial Relief
IHA’s summer financial data survey found that 88% of participating hospitals have a negative or razor thin operating margin and of those, 58% are below -2% and 22% are below -10%.
There has been over a 50% increase in contingent staffing spending compared to last year. Upstate New York hospitals who responded to the IHA survey are now expected to spend over $1.2 billion on contingent staffing in 2022. Over the past two years traditional staffing agencies have raised rates to extreme levels, taking advantage of an already overburdened system.
Upstate Hospitals are in a perilous situation, balancing between safe staffing levels and going under financially. This cannot continue without causing harm to the patients and communities that these institutions serve.
This survey, and others, assist IHA greatly in our advocacy with policy makers. We bring the data to our conversations to show the inarguable truth, that healthcare Upstate is in peril.
From 2010 to 2021, 136 rural hospitals across the country closed. 9 of the closures happened in 2020 alone, which was more than any other year. In 2021 the number dropped down to just 2 rural hospital closures. The American Hospital Association attributes the decrease in closed hospitals to COVID-19 relief funds that acted as a lifeline to struggling rural hospitals.
Throughout discussions with State leaders, it is a priority for IHA to ask the State to provide increased financial support that is critical to the survival of Upstate healthcare. The data we collect from members is a driving force behind our advocacy, and is an integral tool to ignite action by legislators. IHA will continue its steadfast advocacy for increased financial relief to ensure Upstate and rural healthcare remains intact.
Political Landscape
Primary elections were held in June for State Assembly and the governor’s race, and in August for the State Senate and U.S. House of Representatives.
Governor Hochul sailed past challengers Jumaane Williams and Tom Suozzi in the Democratic primaries, we now wait until November for the general election. Hochul’s competition is Republican Lee Zeldin, in the first New York’s governor’s race to have only two candidates since 1946. Hot button topics that could have an effect on voters are reproductive rights, gun ownership laws, and Zeldin’s ties with former President Trump. Siena College polls have had Hochul leading by more than 10 points for the past several months, however we still have a but of time before voters hit the polls.
2022 saw more retires and resignations than usual, opening up both houses of the legislature for an inordinate number of freshman policy makers to join the ranks. If all incumbents win their seats, there will be 17 new members in the Assembly and 12 new members in the Senate. We are still waiting on who will take the place of Assembly Health Chair Richard Gottfried (D), who retired this year.
We will follow the elections closely and will communicate a thorough summary highlighting the potentially impactful results upon their conclusion.