Comparison of Executive, Senate and Assembly One House Budget Proposals Health/Mental Hygiene Executive Budget Senate One House Assembly One House MULTI SECTOR/ HOSPITAL Increase in Minimum Wage from $9 to $10.50 across NYS and to $11.50 in NYC Make Global Spending Cap permanent and increase to $17.9B Certificate of Need (CON) Redesign, 2012 Public Health and Health to increase minimum wage Modifies Executive proposal by sun setting Commissioner s authority March 31, 2016 Modifies Executive proposal to: Modifies Executive proposal by increasing to $10.50 per hour on December 31, 2016, and to $12.60 per hour on December 31, 2018. In New York City, Westchester, Nassau and Suffolk Counties, the minimum wage would be higher than the rest of the State, at $12.50 per hour at the end of 2016 and $15.00 per hour two years later. Effective December 31, 2019, minimum wage would be indexed to inflation. Modifies Executive proposal to permanently codify spending cap and instead extends for one year 1
Planning Council (PHHPC) Recommendations Decrease character and competence look back period from 10 to 5 years; Apply existing timeframes for Article 28 FQHC CON and other Article 28 providers; and Include improper delegation of authority as justification for DOH to appoint a temporary operator to a facility. Includes a new provision to require full CON review for a hospital sponsored offcampus emergency department located in towns with a population greater than 12600 and less than 12,700 people. Private Equity Demonstrations to allow for five private equity businesses to operate a hospital or home care agency Modifies Executive proposal to: Allow up to 10 private equity businesses; Eliminate a requirement that the governance model reserve powers granted to a local governing authority; Eliminate requirements for a local advisory board and for presentation of certain information by the entity including but not limited to the time period that it expects to 2
keep its investment in a hospital and the role of the not for profit hospital partner in discussions with a subsequent investor. New Hospital Capital Fund $1.4B ($700M NYC/Brooklyn; $400M Upstate; $300M Oneida County) Vital Access Provider (VAP) funding increase of $290M DSRIP/ Value Based Payments (VBP) under Medicaid statutory authority Modifies Executive proposal by combining $1.4B into larger Capital Restructuring Finance Program to Support IT Investments, Debt Retirement, Restructuring, closures, mergers, etc. ($3.1B); Includes criteria, application and eligibility language for providers including hospitals nursing homes, home care, clinics, D&TCs, primary care providers and others; Proposes to fund the All Payer Database, SHIN NY and Health IT from this fund; Proposes up to $1 billion for NYC; $300M for Oneida County; and $400M for rural hospitals Modifies Executive proposal by providing level funding and requires that at least 40% of awards be provided Upstate Modifies Executive proposal to provide $190M increase and allots $7.5M for critical access hospitals and $10M for providers serving rural and isolated geographic areas SHIN NY funding of $45M ; Fund 3
through Capital Restructuring Finance Program described on page 1 All Payer Database funding of $10M New $50M Nonprofit Infrastructure Capital Investment Program Cost of Living Adjustment continued from 2014 15 (2% more added for direct care staff and new 2% for clinical staff) ; Fund through Capital Restructuring Finance Program described on page 1 Includes new proposal for each DSRIP PPS to have a Community Advisory Board Includes new proposal to create a new Independent Consumer Advocacy Network independent ombudsman within NYSDOH to assist Medicaid enrollees with Managed Care Includes new proposal to create a new Health Technology Assessment Committee to make recommendation to NYSDOH related to Medicaid coverage for devices and technology Includes new proposal to create a new Health Technology Assessment Committee to make recommendation to NYSDOH related to Medicaid coverage for devices and technology Includes a new proposal to provide presumptive Medicaid eligibility for 4
individuals within 60 days of release from prisons or local jails AMBULATORY CARE Proposes regulation of Limited Services Clinics Proposes regulation of Urgent Care centers Includes new proposal to require hospitals, office based surgery practices and Title 8 providers who accept unscheduled, walk ins and extended hours to utilize EHR systems that connect to local RHIOs Includes a new proposal to create a hospital, home care and physician collaboration program to facilitate innovation Includes a new proposal to require that at least 2.5% of health workforce training funding be given to each region Includes a new proposal to increase covered lives gross amount to Rochester by $110 million for funding GME restoring $5 Million Includes a new proposal to increase covered lives gross amount to Rochester by $110 million for funding GME New requirements on Office Based Modifies Executive proposal to: 5
Surgery (OBS) facilities Require NYS DOH to convene an OBS workgroup to recommend & report by 12 1 2015; Authorize a facility fee; and Authorize suspension or revocation of licensure after removal of accreditation. to: Include visit to an ED or admission to a hospital within 72 hours of surgery in the definition of adverse event ; and Require quality improvement activities HOME CARE/LONG TERM CARE Eliminates refusal of spousal support Provides exemption from Nurse Practice Act for Advanced Home Health Aides (AHHA) without prejudice until the recommendations of a workgroup are completed. Modifies Executive proposal to prohibit Advanced Home Health Aides from the administration of medications by injection other than insulin for diabetes care, sterile procedures, and central line maintenance and requiring a system for drug diversion. In addition, establishes additional supervision standards by a registered professional nurse. 6
Includes new proposal to require the Establishment of Uniform Billing Codes for MLTCs and mandatory Electronic Funds Transfer for payments by MLTCs Includes new proposal to require any contract by a health care plan with certified home health agencies, long term home health care programs, licensed home care services agencies, or fiscal intermediaries in the consumer directed personal assistance program shall ensure that resources made available by the health plan under such contracts or agreements will support the retention of a qualified workforce capable of providing quality care. PHYSICIANS/HEALTH PROFESSIONALS Level funding for Excess Medical Malpractice Program $127.4M; Includes new proposal requiring eligible individuals to obtain tax for $127.4 Million, Extends program to 2016 and Rejects Tax & Finance Clearance Requirements Rates must sufficiently support home care worker wage parity compensation requirements, and the recruitment, training and retention of direct care personnel in both wage parity and nonwage parity regions. s for $127.4 Million, Extends program to 2016 and Rejects Tax & Finance Clearance Requirements 7
clearance from Dept. of Taxation & Finance Funding for Doctors Across NY (DANY) Funding ($1,705,000 Loan Forgiveness/ $4,360,000 Practice Support) Proposes to remove Physician Profiles website Establishes Ebola Healthcare Workers Bills of Rights PHARMACY Proposes AWP cut to pharmacy Medicaid reimbursement; $4.50 adjustment in pharmacy dispensing fees for brand name drugs 340B Drug Reimbursement change proposed Includes new proposal to extend RBC Exemptions to 2019 and includes $2 million in additional funding for DANY; Proposes to increase number of DANY slots by 100 Includes a new proposal to authorize house calls for physicians employed by Article 28 facilities Includes new proposal to extend RBC Exemptions to 2019 Eliminates prescriber prevails Authorizes NYSDOH to negotiate directly for supplemental rebates with manufacturers 8
Authorizes requiring prior approval for certain drugs prior to approval from the Drug Utilization Review Board Eliminates Prescription Drug Saver Program Extends CDTM teaching hospital pilot for three years Removes limitations on syringe sales and ban on advertising of sales PUBLIC HEALTH Proposes to consolidated public health and workforce programs into 5 block cuts; 15% cut to each block to extend teaching hospital pilot three years and replaces with language to create a 15 community site CDTM demonstration and make law permanent Includes a new proposal to provide for prescriber prevails for all drug classes under Medicaid Managed Care Includes a new proposal to expand mail order consent law to include out of state mail order pharmacies and change consent requirement to be in same manner as used by Medicare Part D to consolidate programs and restores cut Modifies Executive proposal to extend CDTM teaching hospital pilot for seven years with some modifications Includes a new proposal to provide for prescriber prevails for all drug classes under Medicaid Managed Care to consolidate programs and restores cut 9
Level funding for tobacco control program $37,558,600 Level funding for stem cell program $44.8 million Proposes series of HIV/AIDs prevention measures (End the Epidemic) Includes a new proposal to create an umbilical cord blood banking education program with some modifications Includes $7.5M in new funding for the Healthy Food, Healthy Communities program BEHAVIORAL HEALTH Child Health Plus Rate Increase for Behavioral Health providers through 12/31/16 in NYC and 7/1/17 rest of State Proposes up to $5M for health homes and criminal justice system Extends for one year to 2016 OMH's authority to recover Medicaid exempt income from providers of community residence Modifies Executive proposal so rate increases run through 12/31/18 Modifies Executive proposal so rate increase runs through12/31/17 10
Extends for three years to 2018 the pilot program to restructure educational services for children residing in OMH hospitals Extends for three years to 2018 OMH facility director authority to use funds for care and treatment consistent with federal laws/regulations Includes $50M for VAP Behavioral Health providers Includes savings from State operated psych facility bed reductions Modifies Executive proposal to include language in statute specifying that minimum of $30M of the $50M must go to Article 31 and 32s and includes eligibility requirements in line with those that exist for broader VAP funding for providers Includes $8.1 million to reject 137 bed reductions in State operated psych facilities Includes language to limit number of beds to be reduced, clarifying that no facilities will be closed, and requiring 12 months notice on significant service reductions Includes new proposals related to legal and illegal gambling Includes a new proposal to create a Mental Health Crisis Intervention Demonstration program including inpatient diversion programs; Includes 11
$1M in funding for initiative Includes a new proposal to extend Medicaid Managed Care APG rates for behavioral health provide through 6/30/18 for NYC, 9/30/18 outside NYC, and 12/31/18 for kids (under 21) Includes a new proposal to require monthly reports by Commissioner to Legislature on community reinvestment and inpatient census in state psych facilities, readmissions to hospitals/eds and community reinvestments Includes a new proposal to establish a single point of access wait list for those seeking housing and services in OMH system; Provides $500,000 Includes a new proposal to create an opioid overdose prevention program with schools Includes $20M in new funding for IT and other infrastructure for non profits related to behavioral health transition to Managed Care DEVELOPMENTAL DISABILITIES Proposal to clarify that OPWDD has authority to oversee nurse related with some 12 with some modification to clarify that OPWDD s
services in non certified settings modifications oversight responsibilities are not expanded Includes new language to restore the MRT #26 cut to Article 16s Includes new language to incorporate the Peoples First Bill vetoed in 2014 Includes new language requiring an integrated housing plan Includes new language incorporating the Front Door Bill vetoed in 2014 Includes new language incorporating the Employment First Choice Act Includes $5M for development of new opportunities for those living with aging parents Includes a proposal to establish a OPWDD transformation workgroup to develop a plan for transition of OPWDD services into community in most integrated settings Includes language to require OPWDD to conduct a geographical analysis of supports and service needs in the community setting and to ensure proper transition from institutions into the 13
EARLY INTERVENTION community SPECIAL EDUCATION Allows for school district waivers from state education requirements for handicapped children Changes to preschool special education reimbursement rates INSURANCE Insurance assessment to fund NYS of Health Benefit Exchange $35.7M for implementation/ administration of Basic Health Plan Includes new language to reinstate NYSDOH report to the Legislature related to early intervention services with one modification to implementation date of the new rates to begin in the 2016 17 school year instead of the 2015 16 and still phased in over four years Includes new proposal to create a new Insurance Modernization and Quality Care Commission to evaluation proposed health insurance mandates 14
Includes a new proposal requiring plans to provide listing of participating providers to NYSDOH and notify the Department within 15 days of changes to plan s network Includes a new proposal requiring an actuarial memorandum with date/methods for how managed care provider rates are developed with annual report to Legislature 15