April 1, 2015

Early this morning, the Legislature finalized the $142B state budget for FY 2015-16. While the final budget included an additional $1.4B ( a six percent increase) in school aid and incorporated additional ethics disclosure requirements, legislative leaders agreed to address criminal justice reforms, a proposal for property tax rebates, a measure to address sexual assault on college campuses and an education tax credit and legislation that would allow undocumented immigrants access to tuition assistance—known as the Dream Act—outside the context of the spending plan.

Your MSSNY successfully advocated for its physician members and patients on numerous fronts, defeating several proposals under discussion that would have imposed huge new costs and administrative obligations on physicians.

The final budget restrains state operating spending to two percent growth and includes $1.5 billion for an economic development competition in upstate New York as well as $500 million to help develop broadband.

The final budget did not incorporate an additional tax on health premiums which had been slated to pay for the operation of the Exchange when federal funding runs out later this year. Existing Health Care Reform Act (HCRA) monies will be used to fund Exchange operations.

With regard to HCRA, the budget creates a Health Care Reform Act (HCRA) Modernization Task Force, “to evaluate and make recommendations regarding the efficacy and transparency of the Health Care Reform Act resources fund (HCRA fund) and to evaluate and modernize the provisions of law related to the Health Care Reform Acts of 1996 and 2000.”

The final budget will allow the Basic Health Plan to move forward by providing DOH with authority to develop reimbursement methodologies and fee schedules. It requires a report to the Legislature describing the financial impact of the program and its potential effect on other insurance products available on the state’s health exchange, and to develop a “contingency” plan in the event the federal government, which will fund the majority of costs for the new BHP enrollees, decides to defund the program.

The budget requires more accountability for expenditures made in support of the State Health Information Network of New York (SHIN-NY). Beginning September 1, 2015 and quarterly thereafter, DOH must post on its website the uses of funding which goes to support the SHIN-NY including how it is being used to support hospitals, physicians and other providers in achieving meaningful use; how it is being used to support DSRIP and how it is being used to increase participation in regional health information organizations (RHIOs).

The requires the Commissioner by January 1, 2016 to prepare a report on the implementation of the State Health Innovation Plan (SHIP).

The Legislature rejected the Administration’s proposal to authorize the Department of Health to create a value-based payment structure for health care providers.

The Legislature also rejected the Administration’s proposal to allow a demonstration project for private equity investment in hospitals. The final budget agreement did include $1.4 billion in new funding for capital and debt restructuring—$700 million for facility transformation in Brooklyn, $300 million for Oneida County, and $355 million for isolated, rural essential providers

Among issues on which MSSNY strongly advocated:
  1. Excess has been continued at $127.4M for an additional year without the tax clearance language requested by the Executive and opposed by MSSNY.
  2. The Legislature rejected the Administration’s attempt to eliminate the physician profile. The budget requires that monies be re-directed from OPMC for the next two years to pay for the operation of the physician profile system as had been required in the past. No increase to physician registration fees was included in the budget. Budget language codifies the current regulatory requirement that physicians make changes to the mandatory elements of their profile within thirty days of a change; the DOH is required to upload those changes within thirty days of receipt.DOH is required to report on the status of the profiles by 1/1/16 and annually thereafter.
  3. The Legislature rejected the Retail Clinic proposal opposed by MSSNY.
  4. The Legislature rejected the Urgent Care proposal opposed by MSSNY.
  5. The final budget included significant modification to the Administration’s Office Based Surgery proposal:
    • The requirement for physician OBS practices to register with the Department of Health which MSSNY strongly opposed was rejected.
    • The facility fee proposed by Senate one-House which MSSNY supported was rejected.
    • The grant of authority to the Public Health and Health Planning Council (PHHPC) to determine what procedures and type of anesthesia could be performed and/or used by physicians in OBS settings which MSSNY strongly opposed was rejected.
    • Language to recognize as OBS practice neuraxial anesthesia, major upper or lower extremity nerve blocks was rejected.
    • Language that would have included chiropractors and podiatrists within ambit of the OBS law which MSSNY strongly opposed was rejected.
    • Six hour time limitations for procedures /recovery/ discharge which MSSNY opposed were rejected.
    • The proposed change to the definition of adverse event to include a patient’s visit to an emergency room within seventy-two hours of OBS was accepted.
    • The budget authorizes DOH to require licensees to report additional data such as procedure information as needed for the interpretation of an adverse event.
    • The budget also authorizes the Commissioner to enter into agreements with accrediting agencies to require all OBS practices to conduct QI/QA, carry out surveys and incident reports. Information collected, maintained and reported to DOH and accrediting agencies and maintained in OBS practices confidential and not subject to disclosure pursuant to CPLR and Public Officers Law, a provision which MSSNY supported.
  6. Re-appropriations to MSSNY for the Veterans Initiative were included at $150K and $165K respectfully.
  7. MSSNY’s Committee for Physician’s Health was appropriated $990,000.
  8. An additional $4M was included for the Doctors Across New York Program. It is anticipated that the monies will be used to fund an additional 70 loan forgiveness slots over two years.
  9. The Executive proposal to eliminate prescriber prevails in Medicaid fee for service was rejected. ¬
  10. The Legislature agreed with the Executive Budget proposal to eliminate the fees physicians currently have to pay to initiate a Workers Compensation arbitration proceeding.

We would like to thank all of you for your advocacy on these issues—whether you came to Albany for Physician Advocacy Day or sent a letter or spoke directly with your elected representatives – physician advocacy on these issues made a substantial difference thus assuring these positive results.

Your Lobby Team,
Liz, Moe, Pat and Barb