More on Advocacy Update – Summer 2022 Newsletter

While the State Legislature did adjourn as was expected in early June, there were a pair of decisions from the Supreme Court of the United States that brought them back in an extraordinary session just before the Fourth of July Holiday. One case dealing with women’s reproductive rights, the other dealing specifically with New York’s statutory structure as it relates to the unrestricted right to carry a concealed hand gun.

This legislative session—indeed the last year—has been an unbelievable zenith of this COVID era. As we navigated new COVID variants, vaccine mandates, staffing challenges, and the need for additional resources, Iroquois was there with you assisting with calibrating to a new political landscape led by a new Governor and not one, but two new Lieutenant Governors. In addition, the political landscape continues in flux as the legislature and House of Representatives face a set of split primary elections—June for the Assembly and August for the House and State Senate.

As the weather gets warmer and Albany seemingly gets quieter, IHA continues its advocacy efforts to address new policies resulting from the 2022 legislative session. During the course of the 2022 session, the legislature passed an astounding 1009 bills for the Governor’s consideration. Among those bills are several of interest to IHA members and are outlined below. Rest assured that IHA is and will continue its advocacy on the bills with importance for its members.

IHA spent the last several months regularly communicating the unique needs of IHA members to legislators, the Department of Health and the Governor throughout the budget process, and after, until the end of session. IHA will continue its work now through the end of the year as the Governor begins considering bills passed by both houses.. Looking forward, IHA continues its work off-session to educate and inform leaders about our members unique needs that are so imperative to the health and wellness of Upstate and rural communities. This will become increasingly important after the elections when the 2023 legislative class is seated, as there is expected to be a large number of new legislators resulting from retirements and primary results.

IHA thanks all of its members for the contributions they made during the FY 2023 budget season and the 2022 legislative session. The data that members supply us with bolsters our advocacy efforts and paints a vivid picture for legislators to understand the impact of their policy decisions.

NYS FY 2023 Enacted Budget

After the budget was passed, a week late, IHA combed through and analyzed the statutes to communicate points of interest to IHA member hospitals. Although we did not achieve everything we sought, there were concrete and meaningful wins for the IHA membership.

Inclusion of Critical Access Hospitals and Sole Community Hospitals in Appropriation Language

IHA was stalwart in its advocacy to ensure that the legislature add language in budget appropriation provisions to specifically include Critical Access Hospitals (CAHs) and Sole Community Hospitals (Soles) as eligible institutions to receive financial support from the State. This is critically important in a year where billions of dollars have been allocated to support health care. IHA met with numerous lawmakers, legislative leaders, the Governor’s staff, and budget makers to highlight the oversight of excluding this language. IHA is proud of its success in this endeavor, as CAHs and Soles are specifically named in the statue to receive funds. The incorporation of the CAH and Sole designation ensures that hospitals providing care to rural populations will be assisted financially.

Ensure Payer Mix Threshold Does not Disqualify Upstate Hospitals From Financial Relief

IHA also fiercely advocated to exclude a minimum Medicaid payer mix threshold from the eligibility criteria for funds. Omitting a minimum Medicaid threshold in the consideration for funding eliminates the opportunity for Upstate and rural hospitals to be neglected because of their relatively low proportion of Medicaid in their payer mix.

Health Care Worker Bonus

Included in the budget was $1.2 billion for health care worker bonus, intended to attract talented people into the profession and retain those who have been working the past two years. Employees who have worked under one employer for at least six months are eligible for two bonuses at most, not to exceed $3,000. The legislation includes a long list of health care workers eligible for the bonus that includes RNs, LPNs, NPs, PAs, medical techs, pharmacists, and many more. The bonus amounts are based on a tiered system of how many average weekly hours an employee worked during the vesting period. Employers are responsible for tracking how much employees are eligible for, paying them in a timely manner and submitting claims to DOH for reimbursement. DOH has yet to release guidance on how to pay out or receive reimbursements for the bonuses. IHA will communicate to members with more information as it becomes available.

Increase Medicaid Rates for All Providers

$7.7 billion over four years was allocated to increase the home care worker minimum wage by $3. Although IHA believes that all health care workers should be paid a fair rate, we advocated that funds be spent in a manner that would benefit workers across the continuum of care, as opposed to one sector.
In this regard, IHA had many discussions surrounding the dire need for a substantial increase in the Medicaid reimbursement rate. We communicated the facts that for change to occur, a serious investment in healthcare needed to be made. IHA urged a 7 – 10% increase in Medicaid rates as a fairer methodology to address the recruitment and retention needs of providers across the health care spectrum. Unfortunately, included in the final budget was a 1% Medicaid increase.

Data Driven Advocacy

IHA met with the Senate and Assembly Health Committees, Finance Committees, legislators from both houses, as well as the executive chamber on numerous occasions throughout budget discussions. We presented a strong case based on IHA’s data driven advocacy. Thanks to IHA members responsiveness we are able to bolster our advocacy with the use of relevant data regularly provided to us by our members, to convey the needs of Upstate and rural hospitals. Policymakers express a good deal of respect and a better understanding for the context that IHA brings using this data.


Over the course of the 2022 Legislative session IHA tracked hundreds of bills. The following bills were passed by both houses of the legislature and await consideration by Governor Hochul. IHA will continue to communicate its position on these bills and urge the Governor to act consistent with IHA’s position.

Wrongful Death

IHA Opposed
A.6770/S.74-A aims to expand the nature of wrongful death actions and would exponentially increase insurance costs on New York civil defendants, both public and private. The current law only hold economic losses as cause for compensation, while this legislation would include non-pecuniary injuries such as grief, anguish, loss of love, etc. over turning longstanding statutory law.

The legislation would also expand the parties eligible to receive compensation to include parents, grandparents, step-parents, siblings and gives the court discretion to name other relationships as eligible as well.

IHA believes that expanding the law, as this bill proposes would lead to ambiguity, differing rulings and unjust results.

New York currently has many avenues for financial recovery, this legislation would dramatically increase costs for damages.

If signed by the Governor this legislation would take effect immediately and would apply to all pending actions and actions commenced on or after such date.

Patient Liens

IHA Opposed
A.7363-A/S.6522-A enacts barriers to levying property liens against a debtor’s primary residence and wage garnishment in actions arising from medical debt.

The inability for health care organizations to impose property liens against patients with medical debt decreases the opportunity for organizations to collect payments. Hospitals and health organizations will have increased difficulty obtaining money that is owed to them, jeopardizing their finances and potentially impacting their bottom lines.

If signed by the Governor this legislation would take effect immediately.

Surgical Smoke Exposure

IHA Opposed
A.9974/S.8869 would require general hospitals to adopt and implement policies to prevent exposure to by-products generated from the use of an energy generating surgical device. These policies would be used to capture, filter and remove surgical smoke resulting from procedures that produce surgical plume and other air contaminants.
Installing equipment such as this would come at a significant cost to hospitals. IHA sent a memo to law makers describing the excessive burden that a bill such as this would create for already struggling hospitals. IHA communicated that while we think the objective of the legislation is positive, there needs to be financial support from the state to assist healthcare organizations obtain the necessary equipment. Without proper backing, imposing costly mandates onto hospitals is unfair and dangerous.

If signed by the Governor this legislation would take effect on the one hundred eightieth day after it shall have become a law. Effective immediately, the commissioner of health shall make regulations and take other actions reasonably necessary to implement this act on that date.

Nurse Consecutive Hours

IHA Opposed
A.286-A/S.1997-A would enact civil penalties on employers that require a nurse to work more than such nurse’s regularly scheduled work hours and provides that the employee shall receive an additional fifteen percent of the overtime payment from the employer for each violation.

If signed into law by the Governor, this legislation would take effect on the sixtieth day after it shall have become a law.


A.8169-A/S.7199-A prohibits certain provisions in health plan contracts including most-favored-nation provisions and restrictions on disclosure of actual claim costs, priced or quality in certain situations.

If signed into law by the Governor, this legislation would take effect on January 1, 2023 however it would not work retrospectively, so it would not affect contracts before that date.

Acute Children’s Hospital

A.3511-A/S.3530-A relates to adding an acute children’s hospital to the term enhanced safety net hospital.

If signed into law by the Governor, this legislation would take effect immediately.

Primary Care Reform Commission

A.7230-B/S.6534-C would establish the primary care reform commission to review, examine, and make findings on the level of primary care spending by all payers in context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.

If signed into law by the Governor, this legislation would take effect immediately.

Medicaid Assistance Program Funds

A.7889-A/S.4486-B amends provisions relating to audit and review of medical assistance program funds by the Medicaid inspector general; prohibits additional review without error or new information; required application of riles in place at the time funds were paid to providers; required notice to recipients of medical assistance funds of certain investigations.

If signed into law by the Governor, this action would take effect immediately.

Provision of Informed Consent

A.9677/S.1172-C expands requirements for the provision of informed consent.

If signed into law by the Governor, this legislation would take effect on the first of January next succeeding the date on which it shall have become law. Effective immediately, the addition, amending and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed on or before such effective date.

Billing of Facility Fees

A.3470-C/S.2521-C relates to regulation of the billing of facility fees; requires notice prior to billing facility fees not covered by a patient’s insurance; defines facility fees as those charged by a hospital, facility or provider designed to compensate for operational costs separate from professional fees.

If signed into law by the Governor, this legislation would take effect on the one hundred eightieth day after it shall have become a law.

Price Gouging of Medicine

A.5860-B/S.3081-B prohibits selling a drug subject to a shortage for an unconscionably excessive price, which will be determined by courts based on the price, an exercise of unfair leverage or a combination.

If signed into law by the Governor, this legislation would take effect immediately.

Patient Rx Information and Choice Expansion

A.5411-D/S.4620-C required health plans operating in the state to furnish the cost, benefit, and coverage data as required to the enrollee, his or her health care provider, or the third-party of his or her choosing.

If signed into law by the Governor, this legislation would take effect one hundred eighty days after it shall have become a law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorize to be made and completed on or before such an effective date.

Hours Worked by Nurses

A.181-A/S.8445-A includes home care services in certain requirements regarding restrictions on consecutive hours of work for nurses, and regarding nurses’ refusal of overtime work.

If signed into law by the Governor, this legislation would take effect on the ninetieth day after it shall have become law.

Diverse Sexual Orientation & Gender Identity Training

A.1880-A/S.2534-A requires home health aides and nurse’s aides to receive training in working with patients of diverse sexual orientations and gender identities or expressions as part of the education and training for certification.

If signed into law by the Governor, this legislation would take effect immediately.

Mental Injury

A.2020-A/S.6373-A relates to claims for mental injury premised upon extraordinary work-related stress incurred at work.

If signed into law by the Governor, this legislation would take effect on the first of January next succeeding the date on which it shall have become law.

Compensation Disclosure

A.10477/S.9427-A required employers to disclose compensation or range of compensation to applicants and employees upon issuing an employment opportunity for internal or public viewing or upon employee request.

If signed into law by the Governor, this legislation would take effect on the two hundred seventieth day after it shall have become a law.

Demographic Data Reporting

A.8449/S.8435 requires certain companies and corporations to report certain data regarding the gender, race and ethnicity of their employees.

If signed into law by the Governor, this legislation would take effect two years after it shall have become a law.

Lawful Absences

A.8092-A/S.1958-A clarifies that workers shall not be punished or subjected to discipline by employers for lawful absences.

If signed by the Governor, this legislation would take effect on the ninetieth day after it shall have become a law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed on or before such date.

The following bills are ones that IHA tracked throughout but did not pass both houses during the 2021-2022 session.


IHA Opposed
A.1812/S.933A would expand New York’s anti-trust laws and enact substantially increased penalties to infractions of anti-trust behavior. The bill increases the maximum fine from $100,000 to $1 million and the maximum imprisonment term from 4 years to 15 years.

The bill also significantly broadens how the law defines anti-trust behavior and re-considers monopolies as any seller who has a share of forty percent or greater in a market or any buyer who has a share of thirty percent or more of a market.

The bill contains several measures that IHA finds will prove harmful to the vitality of CAHs, Soles and the development of the healthcare industry as a whole.

IHA expressed concerns to the legislature about this bill via memo and individual conversations. Although is a win that this legislation did not pass both houses this legislative session, we expect it to return next year.

Simulation Training

IHA Supports
A.7767-A/S.6717-A would amend the education law to allow for a one-third of required clinical training and competency be completed through simulation experience.

The legislation would change the educational requirements for registered professional nurses, licensed practical nurses and nurse practitioners.

The option of completing a portion of required training via simulation would decrease the reliance we have on instructors and allow for more flexibility in the training of aspiring medical professionals. IHA supports this legislation and believes that it will assist in building the pipeline of healthcare careers to the industry which is facing a severe deficit.

We will work with legislators over the next year to bring this bill back in the next session and educate them on the positive outcomes it could have for healthcare.

Feeling Rural Good License Plate Fund

IHA Supports
A.9748/S.8616 would amend vehicle and traffic law establishing a distinctive “Feeling Rural Good” license plate for any person residing in this state upon request. Revenues from such a program will be collected into a fund and used for the purposes of closing gaps in access to health care. This program would create a shared sense of identity among rural New Yorkers, raise awareness about low access to health within the population and present an opportunity for individuals to contribute to progress.

This bill will be reintroduced next legislative session and IHA will communicate with lawmakers the many benefits.

The following bills embody the package of bills in relation to women’s reproductive health that were recently signed into law.

Abortion Service Provider Protections

A.10372-A/S.9077-A provides certain legal protections for abortion service providers including protection from extradition, arrest and legal proceedings in other states relating to abortions legally performed in this state.

Signed into law as chapter 219 of the laws of 2022 and takes effect immediately.

Relates to Abortions, Professional Misconduct

A.9687-B/S.9079-B prohibits professional misconduct charges against health care practitioners on the basis that such health care practitioner, acting within their scope of practice, performed, recommended or provided reproductive health care services for a patient who resides in a state wherein reproductive health services are illegal.

Signed into law as chapter 220 of the laws of 2022 and takes effect immediately.

Relates to Unlawful Interference

A.10094-A/S.9039-A establishes a cause of action for unlawful interference with protected rights.

Signed into law as chapter 218 of the laws of 2022 and takes effect immediately.

Protection for Abortion Providers

A.10372-A/S.9077-A provides certain legal protections for abortion service providers including protection from extradition, arrest and legal proceedings in other states relating to abortions legally performed in this state.

Signed into law as chapter 219 of the laws of 2022 and takes effect immediately.

Reproductive Care Confidentiality Program

A.9818-A/S.9384-A provides address confidentiality to protect reproductive health care services providers, employees, volunteers, or patients.

Signed into law as chapter 222 of the laws of 2022 and takes effect ninety days after it was signed.

Unmet Health Needs Study

A.5499/S.470 authorizes the Commissioner of Health to conduct a study and issue a report examining the unmet health and resource needs facing pregnant women in New York and the impact of limited service pregnancy centers.

Signed into law as chapter 217 of the laws of 2022 and takes effect immediately.

Medical Malpractice Insurers and Actions

A.9718-B/S.9080-B prohibits medical malpractice insurance companies from taking any adverse action against a reproductive health care provider who provides legal reproductive health care.

Signed into law as chapter 221 of the laws of 2022 and takes effect immediately.

Healthcare Workers Filing for ERPOs

A.10502/S.9113-A authorizes certain health care providers to file an application for an extreme risk protection order against a person examined by such health care provider in certain circumstances

Signed into law as chapter 208 of the laws of 2022 and takes effect thirty days after it was signed.

Clinical Staffing Committees and Plans

IHA has long adamantly opposed the passage and approval of Public Health Law Sec. 2805-T regarding general hospital staffing committees. Proposed rulemaking (I.D. No. HLT-07-22-00010-P), which would implement this law has been published for public comment. IHA submitted a letter to DOH outlining our concerns and requesting necessary safe harbor provisions regarding enforcement of clinical staffing committees. In the letter, we highlighted the dire workforce crisis facing hospitals across Upstate New York, and how this proposed rulemaking would only amplify the problem.

IHA expressed to DOH that one-size-fits-all solutions often negatively impact Upstate and rural hospitals. The letter explained that increased recruitment and retention efforts have been difficult due to a depleted labor pool, and the need to fill those gaps with traveling nurse staff has resulted in significant financial burden. IHA urged DOH to include a fact-based standard that measures hospital staffing vacancy rates, and a scale based with considerations such as hospital size, resources, geographic location, etc.

IHA included several more factors that were overlooked in the statute and proposed rulemaking. We will continue to communicate with DOH and utilize our experience and extensive data to advise on a better solution.
As of July, and despite IHA’s constant advocacy, DOH has not adopted any regulations or provided guidance regarding Clinical Staffing Committees or Plans. IHA strenuously advocated for DOH to delay the July 1, due date for submission of plans until no earlier than 60-days after DOH either adopts regulations or provides guidance on staffing plans. While there was some indication this was getting serious consideration, DOH opted to leave the submission date unchanged. Moreover, DOH has required an additional submission via HERDS survey in order to uniformly capture information. Again, IHA had advocated the DOH delay all submissions unless or until there is clear guidance regarding submissions. Likewise, IHA urged DOH that it must provide a webinar to explain all that is expected.

Critical Access Hospital Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) proposed altering the CAH designation criteria, based on the CAH State Operations Manual published in 2015. This changed the definition of a primary road to include any road “in the National Highway System, as defined in 23 US Code §103(b)”. This sub-regulatory definition change to include the National Highway System (NHS) roads as a primary road has a severe impact on NYS CAHs.

To obtain CAH status, among several other requirements, a hospital must be located in a rural area and meet the federal distance requirement to be at least a 35-mile drive on primary roads or 15 miles on secondary roads to the nearest hospital or other CAH. The inclusion of the NHS as a primary road could potentially eliminate nine NYS organizations from CAH status, as they would not meet the federal distance requirement.

Due to the Public Health Emergency enforcement of this new interpretation was suspended.

Since this new definition was proposed, IHA has been very active fighting against it. IHA has been in contact with CMS and members of the New York State Congressional Delegation, including Senator Schumer. IHA has outlined the severe consequences this would have on CAHs and the communities that they serve numerous times. Urging CMS against adopting this definition change. We highlighted the importance that CAHs play in their local communities and the devastation that would ensue if they were to close.

In July, CMS released a proposed rule making that would address the mileage issue. The proposal appears to have resolved the issue, but IHA is doing a full analysis and will be submitting comments later in the summer.

Nursing Home Staffing Ratios

Executive Order 4.6 neglected to extend the pause of enforced Nursing Home staffing ratios. IHA has been in conversation with DOH since late March to more thoroughly understand enforcement of this statute. DOH emphasized that Nursing Homes should exercise due diligence in making reasonable efforts to ensure the proper staffing levels and document efforts made to do so. DOH also emphasized that Nursing Homes must not discharge residents for the sole reason of meeting staffing levels. IHA continues to urge DOH to share further guidance given the very real impossibility of Nursing Homes being able to comply with these provisions.

Critically, IHA continues to advocate for DOH to release the funding that was allocated in the last fiscal year and this new fiscal year to assist nursing homes in addressing their staffing issues. Finally, IHA has explained to DOH that reduced bed capacity in nursing homes due to a lack of staff has a ripple effect in hospitals where the number of patients at an alternate level of care awaiting nursing home beds continues to climb reducing hospital bed capacity while further exacerbating hospitals staffing crisis.

1115 Waiver

DOH has submitted a proposed 1115 Waiver amendment to address a number of issues in New York. The proposal originally sought $17.5B and now seeks$13.5B over five years.
In its comments on the proposal, IHA explained that it is of critical importance that the new Waiver proposal address the workforce crisis. IHA has collected data that highlights the fact that the workforce crisis has worsened and is a nightmare scenario
for the State and the communities we serve. The unfortunate and painful truth is that without staff, service lines that communities rely on will cease to exist, limiting critical services in the Iroquois region.

IHA urges the State to seek CMS approval in this arena for the most funding that is possible. The staffing crisis must be urgently addressed with creative solutions, flexibility and serious funding.

The Waiver proposes a Value Based Purchasing pool of $1.5 billion made available to financially distressed safety net and critical access hospitals and nursing homes that have a high Medicaid payer mix. The funding would be targeted to post pandemic improvements.

IHA strongly recommends that DOH closely examine the goal, parameters, amount and targets of this funding. Targets should include Sole Community Hospitals in addition to Critical Access Hospitals, rural providers and public institutions. More over the payer mix threshold to qualify must be closely examined. Upstate and Rural hospitals often have a lower proportion of Medicaid in their payer mix. This is related to population demographics. Upstate hospitals and health systems should not under any circumstances be excluded from accessing these funds due to an arbitrary unachievable Medicaid payer mix ratio.

Moreover, IHA explained that Upstate hospitals are in dire need of direct and immediate funding supports. These hospitals are both financially distressed and
safety net providers in their communities, and should not be overlooked.

IHA posits that a more equitable distribution of these funds would be an across the board increase in Medicaid rates. To that end IHA recommends significantly increasing the funding in this pool and target it equitable distribution. This would be more direct, expedient and equitable.

An Ever-Changing Political Landscape

As with the weather in Upstate New York, if you don’t like it wait a minute and it will change. This seems apropos of the political landscape in the last year. As if this past year had not been chaotic enough Lieutenant Governor Brian Benjamin, running mate of incumbent Governor Hochul, was arrested and indicted on charges of campaign fraud. This news came just 8 months after Benjamin was appointed to the position by Governor Hochul, following the resignation of former Governor Cuomo. Although he claims innocence, Benjamin removed himself from the ballot for re-election.

Governor Hochul has appointed Congressman Antonio Delgado (D-19th) as her replacement LG, he ran successfully in the June primaries to try for a full term in the position. This opened Delgado’s position in the 19th Congressional District during a time that Democrats are fighting tooth and nail to hold the House majority. Delgado has historically been a good campaigner and popular within his district, which are two major reasons that Hochul has tapped him to be her second in command. This is the first time in recent history that the gubernatorial ticket will have both candidates from Upstate.

Not only are the candidates chaotic, but the election process is as well.

A judge in Steuben County ruled that the newly drawn political maps were gerrymandered, and that State Democrats did not have the constitutional authority to draw the maps in the first place. The case was appealed to the Appellate Division in Rochester where a majority of judges agreed that the map was “drawn to discourage competition and favor Democrats”, however, the Appellate Court ruled that Democrats did have the authority to draw the districts.

The next step for the political map was the state’s highest court, the Court of Appeals. The Court of Appeals ruled that the map was drawn with mal intent and that Democrats did not have the authority, therefore the congressional and state Senate maps are to be thrown out. The responsibility to redraw was given to an impartial map drawer appointed by a judge in Steuben County. The Assembly map was challenged several times without impact on this year’s races.

The district lines have thrown a wrench into election primaries that were scheduled to take place in late June. The statewide and assembly races took place on June 28th, however the senate and congressional primaries have been pushed to August.

The new lines have disrupted the election campaigns of several incumbents, primarily in NYC. Most notably, Senate Health chair Gustavo Rivera (D) is now running against a political newcomer without the backing of the Bronx Democratic Party.

This is also the last session for Assembly Health Chair, Richard Gottfried (D), who is not seeking reelection. Gottfried has chaired the Health committee for over 30 years. There is no heir apparent as to who will be his successor.

Also notable, is the primary loss of Assembly Insurance Committee chair Kevin Cahill. The loss of Mr. Cahill and retirement of Mr. Gottfried opens up two very powerful and important committees in the Assembly. This will lead to a likely significant shuffling of Committee leadership in the Assembly. That paired with other retirements in both houses of the legislature means that there will be much work to be done in the coming session to ensure the needs of Upstate and rural hospitals are understood and addressed. And IHA will be there to do that, partnering with all of our members.

In closing, IHA would like to thank its members for the contributions made over the past several months. Without the support from our membership we could not effectively work on your behalf. We will continue the fight for fair recognition and support of Upstate and rural hospitals and advocating for a healthier New York.