Final NYS Budget Agreement: Wins for Primary Care After several weeks of negotiations, Governor Cuomo signed into law New York’s 2018-19 state budget late last week. CHCANYS is very pleased that the $168B budget deal includes several items of importance to primary care, including the following:
Patient-Centered Medical Home Incentive Payment Program The final budget restores the full $20M cut to the PCMH incentive payment programs, an item that CHCANYS strongly advocatied for. While we do not yet have additional details on exactly how the Dept. of Health will implement this restoration, we are extremely pleased that the State recognizes the importance of this funding to primary care providers as they transition to value-based payment.
Safety Net Funding As expected, the final budget maintains level funding of $54.4M for the D&TC Safety Net Fund (previously known at the D&TC Uncompensated Care Fund).
Capital Funding A total of $475M has been allocated to the Statewide Health Care Facility Transformation Program, with a minimum of $60M set aside for community-based providers, including FQHCs. Additional funding has been set aside for the Assisted Living Program (ALP) providers which will not come out of the community-based provider pool.
Telehealth As CHCANYS recommended, the definition of originating site (where the patient is located) has been expanded to “include the patient’s residence within New York State, or temporary location either within or outside New York State.” Additionally, the Dept. of Health, the Office of Mental Health, the Office of Substance Abuse Services, and the Office of People with Developmental Disabilities are required to develop a coordinated document that clearly identifies any differences in telehealth regulations and policies, including those on reimbursement, between the agencies.
Health Homes Cuts to the Health Homes program are much smaller than initially anticipated: $10M this year and $16M next year, for a total of $26M over two years. Health Homes will be required to perform background checks and may be subject to penalties if they fail to meet participation targets. Additionally, in a letter to legislative leaders, the Dept. of Health committed to making several reforms to the program, including an increased focus on quality outcomes, data collection and reporting.
School-Based Health Centers School-based health centers have received $8.3M in grant funding, which includes $4M to restore funds to SBHC that were cut as part of last year’s budget.
Doctors Across New York The final budget maintains level funding for the DANY program at $9M.
Thank you all so much for your strong advocacy during this budget season. We could not have maintained funding for all the items listed above without your ongoing commitment to health centers and their ability to provide high-quality, comprehensive primary care to all New Yorkers
Senate and Assembly One House Bills Released During the week of March 12, the NYS Senate and Assembly released their One House Budget Bills containing their proposed amendments to the previously released Executive Budget (Click to view: Senate / Assembly). Highlights of particular interest to CHCANYS / health centers include:
Patient-Centered Medical Home Incentive Payment Program Both the Senate and the Assembly indicated their opposition to a $20M reduction in Patient-Centered Medical Home incentive payments, although the Assembly restored only half the funding, while the Senate bill included language completely rejecting the cut.
Capital Funding Both Houses increased the total funding for Health Care Transformation Program and the amount available for community-based providers and specified that funding for Assisted Living Program providers (ALP) should be allocated from the general pool, not the community-based set-aside. The Assembly increased the overall pool to $525M and earmarked $75M for community-based providers, whereas the Senate increased the pool to $500M with a $70M set-aside for community-based providers.
Telehealth Both Houses accepted the idea to expand the availability of telehealth services, although they each modified the Executive’s proposed language on this issue.
Integrated Care Both Houses accepted the Executive’s proposal to eliminate thresholds on the volume of substance use and behavioral health services that may be provided at a primary care site.
Health Homes The Assembly rejected the Article VII requirement that Health Homes be subject to background checks. The Senate rejected the Article VII language related to Health Homes and reduced the funding for the program by $100M.
School-Based Health Centers The Assembly added an additional $3.8M for additional services and expenses associated with new and existing school-based health centers to the Executive’s proposal. The Senate rejected the lined out appropriations to individual school-based health centers that were included in the Executive Budget.
Rose Duhan Testifies at Joint Legislative Hearing on NYS 2018-19 Budget CHCANYS President & CEO Rose Duhan testified at a joint Senate Finance and Assembly Ways and Means Legislative Hearing on the health and Medicaid sections of the FY 2018-19 New York State Executive Budget on Monday, February 12. A copy of her testimony is availablehere. Access video of the hearinghere
New York SFY 2018-19 Executive Budget: Issues of Significance to Community Health Centers On January 16, Governor Cuomo announced the major components of his State Fiscal Year (SFY) 2018-19 Executive Budget, which totaled $168.2 B. Facing a projected $4.4 billion deficit, the Governor noted the significant challenges the State will face in order to close the deficit and enact a budget for the upcoming fiscal year, which begins on April 1, 2018. Much of the Governor’s presentation focused upon the extraordinary challenges to New York’s economic viability resulting from the new federal tax structure and the disproportionately negative impacts this structure imposes upon New York State.
While the Governor highlighted his strategy for addressing the damaging impacts of the federal tax structure, he also noted that other federal actions are causing both significant uncertainty and damaging impacts upon the health care system in New York State. To offset these, the Governor proposes the creation of a $1.0 B Healthcare Shortfall Fund that will be supported by a series of revenue raisers, including funds associated with the acquisition of not-for-profit health insurers by for-profit entities. The purpose of the Healthcare Shortfall Fund is to ensure the availability of funding for health services for New Yorkers and reduce the impacts associated with reductions in federal support. It is not yet clear what programs and providers will be eligible for this fund or how these funds will be disseminated. As discussions progress, we will seek greater clarity and assurance that FQHCs will be eligible for funding should there be a reduction or loss of federal Community Health Center funding.
Consistent with prior years, the Governor’s Executive Budget includes a number of proposals of significance to community health centers, including:
Safety Net Pool – The Governor continues funding for the Safety Net Pool at last year’s level of $54.4 M.
Capital Funding – The Executive Budget includes $425 M to support a third year of capital funding for the Health Care Facility Transformation program. The funding will provide support for both capital and non-capital projects that further the State’s health care transformation goals. The Budget sets aside up to $60 M of the $425 M for community-based providers, including clinics licensed by the Department of Health, the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services, and others. From this $60 M carve out, the Executive Budget proposes to earmark up to $20 M for awards to assisted living programs.
Telehealth Initiatives – The Budget includes language to expand the settings in which a patient may be located and receive Medicaid reimbursable telehealth services to include the patient’s residence and any other location where the patient may be temporarily located. The Budget also expands the list of medical professionals who are eligible to provide Medicaid reimbursable telehealth services. In addition, the Budget includes language to clarify that remote patient monitoring may include follow up telephone calls and requests for and the transmission of data in response to prior interactions.
It is worth noting that although the Governor’s State of the State book indicates that the Executive intends to launch a pilot program to provide funding to rural telehealth providers to support the adoption and expansion of telehealth, the Executive Budget does not include any discrete funding to specifically address this initiative.
Health Homes – The Budget proposes to reduce funding for health homes by $67.65 M and establishes targets for health home participation by special needs and high-risk populations enrolled in Medicaid managed care plans. At the same time, the Budget authorizes incentive payments to Medicaid enrollees who are members of health homes for participating in wellness activities and for avoiding unnecessary hospitalizations and unnecessary use of emergency department services.
Patient Centered Medical Homes (PCMH) - The Executive Budget reduces the funding available to support PCMH by $20.0 M. The Budget assumes implementing the reduction through administrative actions, which have not yet been clarified.
School Based Health Centers – Funding is continued for School Based Health Centers at the levels enacted last year. There are no new reductions proposed.
Migrant Farmworker Program – The SFY 2018-19 Executive Budget continues funding for this program at $406,000, which is consistent with prior years’ levels.
2018 State of the State Address: Initiatives of Significance to New York's Community Health Centers On January 3, 2018, Governor Andrew M. Cuomo delivered his eighth State of the State address. The Governor’s address, which exceeded 90 minutes in length, touched upon a multitude of issues, including a broad mention of the Governor’s commitment to ensuring access to health care for all New Yorkers. Consistent with prior years, the Governor’s Office also released a written overview of the Governor’s priorities for 2018, which complements and expands upon the Governor’s address and offers additional details about initiatives touched upon during his address and information about proposals not included in his speech. Click here to access a copy of the 2018 State of the State book. While the Governor did not specifically reference community health centers, there are several initiatives included in his 2018 priorities that are of interest to CHCs and the work they do.
Proposal: Pass the Comprehensive Contraceptive Coverage Act The Governor will introduce legislation in 2018 to codify the Comprehensive Contraceptive Coverage Act, which will ensure access to contraception, including emergency contraception.
Proposal: Require Outreach and a Comprehensive Homeless Services Plan from Each Local Social Services District This multi-prong initiative will require local governments and regional transportation authorities to establish outreach programs to address street homelessness. Additionally, the proposal will require the state Office of Temporary Disability Assistance (OTDA) to work with local social services districts (LDSS) to ensure that the numerous local efforts to combat homelessness are coordinated among all providers of such services, including LDSS and community based organizations.
Proposal: Increase Mental Health and Substance Use Disorder Services for Individuals Experiencing Homelessness This proposal will require OTDA and the Office of Mental Health to coordinate efforts to ensure that Assertive Community Treatment teams are connected to existing shelters, and require the Office of Alcoholism and Substance Abuse Services to make on-site peer delivered substance use treatment services available in 14 existing shelters.
Proposal: Invest When It Matters Most: The First 1,000 Days of Life Building on the recommendations developed by the Governor’s First 1,000 Days on Medicaid working group, this initiative will:
Develop a standardized model of pediatric primary care;
Facilitate group-based models of prenatal care to support pregnant women living in neighborhoods with the poorest birth outcomes in the State;
Enhance home visiting services in three high-risk communities;
Launch peer-family navigator services in non-health care community settings, such as family homeless shelters and drug treatment centers; and,
Provide parents of young children with improved access to evidence based parent-child therapy models.
Proposal: Reverse the Opioid Epidemic This initiative reflects the Governor’s continued focus on the opioid crisis and includes numerous efforts to address this issue, including:
Taking enforcement actions against pharmaceutical opioid distributors for breaching their legal duties to monitor, detect and report suspicious orders of prescription opioids;
Introducing legislation that includes several provisions related to opioid prescriptions, including language to limit opioid prescription refills to seven days without an in-person office visit;
Limiting requirements for prior authorization and co-payments for outpatient addiction treatment;
Directing several state agencies to implement regulatory and policy reforms that increase access to substance use disorder services, such as considering new regulations to include subacute pain as a qualifying condition for medical marijuana; and,
Introducing legislation to add numerous fentanyl analogs and synthetic cannabinoids to the State’s Controlled Substance Schedule, while also giving the Commissioner of Health broad authority to more easily add dangerous substances to the schedule.
Proposal: Enforce Lead Testing The Governor will direct the Department of Health, the Division of Homes and Community Renewal and other state partners to develop a system to ensure that housing authorities and landlords are protecting children from the dangers of lead exposure.
Proposal: Empower Health Care Consumers This proposal includes numerous initiatives aimed at assisting New Yorkers with navigating the health care system and promoting greater transparency regarding health care costs.
Proposal: Expand Access to Health in Rural New York by Expanding Telehealth Services The Governor is proposing two initiatives this year to modernize and expand access to telehealth services. The Governor will introduce legislation that will broaden the settings at which a Medicaid recipient can receive telehealth services. Additionally, the Governor will launch a pilot program to provide support to rural health care providers for telemedicine equipment and IT support.
Proposal: Leverage Hospital Community Benefit Investments to Support Prevention Initiatives Expanding on federal requirements included in the Affordable Care Act, this initiative will require all voluntary non-profit hospitals to include in community service plans information about the investments each hospital is making in community health improvement interventions, including those associated with the Prevention Agenda.
Additionally, the Governor advances several initiatives that could impact populations served by CHCs. These proposals, which are also contained in the book, are related to:
Improving the rights of and protections for immigrants;
Promoting greater tolerance for all New Yorkers;
Serving our veterans;
Setting the right learning conditions for youth; and
Supporting the needs of the modern aging population.