NYAPRS Note: The NYS Assembly took broad latitude in its one-house bill, released yesterday, relative to some of the more dramatic (and pricey) Executive proposals in this year’s budget. The balance may come down to how much control the Legislature will allow the Executive branch (and the state agencies) to have over funding, policy, and programmatic decisions for hospitals and, subsequently, the DSRIP program that aims to dramatically shift the value-stream of healthcare in NY. We expect to see the Senate’s one-house resolution today, and will know more about how the majority is articulating their healthcare vision for the year.
Assembly Budget Modified Cuomo’s Health Care Proposals
Capital New York; Laura Nahmias, 3/10/2015
The one-house budget bills introduced by the Assembly on Tuesday strip some of the larger, more controversial pieces of Governor Andrew Cuomo’s health budget, ignoring several proposals that would increase the administration’s power to remake state health policy.
Among the proposals not included by the Assembly: a sweeping policy change that would give the state wide latitude in determining value-based payments for health care providers, a plan to allow private equity investing in hospitals and a plan that would limit how much providers can charge for drugs in Medicaid-managed care plans.
Each house of the Legislature introduces a one-house budget largely as a statement of the majority conference’s policy priorities as they enter closed-door negotiations between the governor and legislative leaders.
The Assembly’s budget kept intact roughly a quarter of the more than two-dozen health initiatives proposed by Cuomo, including a bill of rights for Ebola health care workers, streamlined regulations governing the establishment of new health facilities, and the expiration of some Medicaid cuts to providers.
But the Assembly made significant modifications to other Cuomo proposals, including some the administration has described as key to its efforts to change the state’s Medicaid program.
For example, Cuomo’s value-based payment proposal in the executive budget would allow the new health-provider teams collaborating under the state’s federally funded Medicaid program transformation (DSRIP) to negotiate value-based payments for providers directly with insurers. Cuomo’s budget would also give the state’s health commissioner a wide berth to develop the formula for payments. The Assembly’s budget eliminated the provision altogether.
The Assembly’s budget also omits Cuomo’s plan to allow a pilot program of private equity financing for hospitals, a measure Cuomo has included in his executive budget proposal for several years running. For-profit hospitals are not currently legal under state law.
The Assembly’s budget also strips some of the $400 million in funding for upstate rural hospitals from the $1.4 billion in capital funding Cuomo proposed for hospitals around the state. Under Cuomo’s plan, $700 million would go toward a new hospital in Brooklyn (or the financing of a new hospital), $400 million would go to rural hospitals in upstate New York, and $300 million would go to health providers specifically in Oneida County. The Assembly’s proposal carves out $15.5 million from the rural hospitals appropriation to restore cuts in Cuomo’s budget to Roswell Park Cancer Institute, and also allocates $10 million from the $400 million appropriation for community health centers.
The Assembly’s bill also eliminates a controversial proposal to limit the amount certain health providers covered by the federal drug discounting program 340-B can charge for drugs prescribed to patients in Medicaid-managed care programs. Cuomo’s proposal would have limited the amount providers could charge to the actual acquisition cost of the drug.
The Assembly’s budget also significantly changes a proposal by the governor’s office to better regulate and license limited service clinics, urgent care centers and office-based surgery and anesthesia facilities. Cuomo’s budget proposal creates a new licensing category for limited service clinics, defines “urgent care” and required urgent care providers to be accredited, and creates new reporting, registration and patient safety measures for office-based surgery centers.
The Assembly’s budget keeps the new regulations for urgent care and office based surgery centers, but includes no proposal to regulate or license “limited service” clinics.