HANYS’ SR 2020-2021state budget testimony

Joint legislative hearing of the Senate Financeand Assembly Ways and Means committees

January 29, 2020

Bea Grause, RN,JDPresident

4HANYSAlways There for Healthcare

40’

Good morning Chairs Krueger, Weinstein, Rivera and Gotifried, and committeemembers. I am Bea Grause, president of the Healthcare Association of NewYork State, representing nonprofit hospitals, health systems and post-acutecare providers across New York. Thank you for this opportunity to discuss the2020-2021 executive budget proposal.

During his annual State of the State presentation three weeks ago, GovernorCuomo stated that “New York has delivered on the promise that healthcare isa right for all, not a privilege for the few.” That is a momentous achievement.

Our members are, and will continue to be, fully committed partners with thestate as we continue historic efforts to transform the healthcare system.

Healthcare quality is ourtop priority

New York’s hospitals, health systems and post-acute care facilities have madesignificant progress in quality improvement efforts by adopting evidence-basedbest practices and implementing data-driven interventions. Recentimprovements include a 19% reduction in sepsis mortality, 35% reduction inhospital-onset Clostridivm difficile and a 23-step jump in state rankings formaternal mortality.

Importantly, our members are sustaining and building on these improvementsbecause the work of optimal patient safety and quality is a journey. HANYS’members pursue excellence all day, every single day. A total of 176 hospitalsparticipate in the New York State Partnership for Patients, a federal safety andquality improvement initiative, and more than 200 healthcare organizationshave joined HANYS’ Commitment to Excellence program. Together, we areworking to build on our successes and stay on the cutting edge.

We are on the front lines of public health challenges and emergencies

Our members serve on the front lines of public health challenges facing all NewYorkers, including the recent threat of coronavirus. New York’s hospitalstackled SARS (also a coronavirus) in 2003, the 2009 flu pandemic, Ebola in2014 and others. We know that prevention and control of novel infections like2019-nCoV will continue to pose unique challenges.

While public health authorities and scientists work tirelessly to learn about thepotential impacts of the newest virus, hospitals and others on the front linesof providing care are employing rigorous infection control practices andstrengthening systems in place to rapidly identify patients with 2019-nCoV andprevent further spread.

We continue to partner with lawmakers to increase organ donations and fightthe misuse of opioids, a scourge that affects families across this state. We alsosupport enhanced restrictions on tobacco use, efforts to limit youth exposure

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to vaping and initiatives to promote greater public safety, such as strongerbicycle helmet safety laws.

New York’s hospitals and nursing homes are also on the front lines ofemergency preparedness. Our healthcare providers stand ready to respond tonatural disasters such as Superstorm Sandy and the devastation our friendsand families have faced in Puerto Rico.

New York’s healthcare providers know the importance of being nimble andadapting quickly to new threats, while maintaining focus on delivering qualitypatient care.

Improving the healthcare system for consumers

We also recognize the need to keep pace with our patients’ evolving needs andexpectations. Our members are working hard to provide patients with easyaccess to meaningful information on services and prices. HANYS’ memberswill continue these efforts in partnership with state policy makers,understanding that we will need other stakeholders, including the payers, tojoin us in our ongoing efforts to keep patients at the center of our healthcaresystem.

To that end, we want to thank the governor for advancing as part of his budgetproposal several critically important, common-sense managed care reforms.These proposals will provide much-needed efficiencies and will not only reduceadministrative waste but will also lead to better patient experiences.

Coverage is key

We stand firmly committed to ensuring access to affordable healthcare andachieving the goal of universal coverage. Thanks to the governor andlegislature, New York is a leader in providing healthcare coverage for itscitizens: 95% of New Yorkers have access to some type of health insurance.We are committed to working to increase that percentage.

Hospitals are economic anchors, but we face serious challenges

Hospitals and health systems across New York play a vital role in improvinglocal economies and communities. Quite often, our members are the largestemployers in their community. Together, they add $170 billion to New Yorkseconomy. Our workforce is the backbone of our facilities, from our nurses anddoctors to maintenance, food service and cleaning staff. Everyone plays a vitalrole in our success and ability to deliver needed services to our patients.

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Keeping our doors open to care for the sick and injured and serving as placesof refuge for those with nowhere to turn is a responsibility and privilege weembrace.

However, our membership continues to face serious challenges, includingworkforce issues.

In a world of advancing technologies, we are working to address an agingworkforce and provider burnout. We support and thank the governor for hisproposal to increase apprenticeships, including those in healthcare. I wouldlike to also thank you for your continued support in ensuring a healthy androbust healthcare workforce.

Further compounding our workforce challenges is this year’s proposedelimination of the excess medical malpractice program, which helps to addressa medical malpractice insurance affordability crisis by funding a secondarylayer of medical malpractice insurance.

Our members, large and small, urban, suburban and rural, provide 24/7healthcare services for all New Yorkers, regardless of their ability to pay. Thisis our core mission. We recognize and applaud the support we’ve received fromthe governor and the legislature in providing vital resources for us to continuethis mission. Please consider continuing infrastructure investments for ourhospitals and nursing homes, should funds become available.

Together, we must continue moving these efforts forward.

HANYS and the hospitals, health systems and post-acute care providers werepresent appreciate the fiscal challenges our state is facing. We want to bepartners in helping to solve these challenges. However, as we move throughbudget deliberations, we ask you to be mindful that cuts to providers put atrisk all of the good work we’ve accomplished together thus far.

Exacerbating the state challenges is the unrelenting assault on the healthcaredelivery system by the harsh and detrimental policies of the federalgovernment, particularly those being generated by the current administration.We’ve seen the implementation of numerous administrative actions by thepresident that have put at risk billions of dollars of federal support, most aimeddirectly at our safety net providers.

These include cuts to the 340B Drug Pricing Program, site-neutral payments,targeting New York through the area wage index and, most recently, proposalsto limit a state’s ability to finance its Medicaid program through supplementalpayments. These cuts exact an overwhelming toll on New York’s healthcareproviders. We are working daily to reverse and minimize the impacts of thesedrastic policies, but the threat remains very real.

Our nonprofit hospitals and health systems are doing all of this despite facingserious financial challenges. The statewide average hospital operating margin

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of 1.7% is the worst in the country, with nearly half of New York’s hospitalsoperating with negative margins.

Our nonprofit nursing homes, whose residents are overwhelmingly insured byMedicaid, are paid significantly below the cost of providing care to theseindividuals. This underpayment contributes considerably to the fragilecondition of our state’s nonprofit and public nursing homes.

We stand readyto help address the Medicaid imbalance

The governor has called for another Medicaid Redesign Team in his 2020-2021 executive budget to address what he has defined as a $2.5 billionMedicaid shortfall. The MRT will do this without imposing any negative fiscaleffects on local governments and, most importantly, without diminishing orreducing services to Medicaid recipients.

It is hard to imagine that amount of money being taken out of New York’shealthcare delivery system without putting a great deal of strain on our alreadyover-stretched hospitals, health systems and post-acute care providers. Thiswill clearly be a challenging and critically important endeavor with impacts thatwill be felt for years.

I’m here today to offer my help and that of my members. HANYS is ready to bepart of the governor’s initiative to bring stakeholders together to address theMedicaid imbalance. We played a key role in the original MRT nearly a decadeago and welcome the opportunity to again be part of the solution now.Throughout this process, we will remain committed to protecting our patientsand the dedicated healthcare professionals who serve them.

We thank the legislature for acknowledging these challenges and continuingto support New York’s healthcare institutions and the dedicated professionalswho serve in them. HANYS is committed to working with state government andall healthcare stakeholders as we pursue our common goal: ensuring that thehighest quality care is accessible and affordable to all New Yorkers. Weappreciate the support of the legislature and governor and look forward tocontinuing the progress we have made together.

Attached is HANYS’ summary chart outlining key healthcare provisions of theproposed executive budget for 2020-2021.

© 2020 Healthcare Association of New York state, Inc.

41 Page

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heSPY

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atedto

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aintainedthrough

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ederalfunding

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federalprovisions

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orm

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theannual

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heprovisions

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inimum

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orethan

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xecutiveB

udget

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ospitals

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aintainsvarious

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viath

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provement

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VA

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riticalA

ccessH

ospitals•

VA

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foressential

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unityproviders

(ruralhospitals)

•S

pecialpaym

entadd-on

forS

oleC

omm

unityH

ospitals

Enhanced

safetynet

programE

liminates

$82m

illionin

funding(M

edicaidgross)

tosupport

“enhancedsafety

nethospitals”

with

ahigh

volume

ofM

edicaidand

uninsuredpatients

andhospitals

operatedby

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apublic

entity.H

owever,

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$50m

illionin

programfunding

(Medicaid

gross)for

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oleC

omm

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ospitals.

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poolm

ethodologyE

xtendsthe

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methodology

foran

additionalthree

yearsto

March

31,2023.

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thetransition

adjustment

or“collar,”

which

currentlycaps

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aximum

hospitaltransition

lossesat

20%and

will

expireD

ec.31.

2020.

certificateof

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posesan

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onall

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equalto

3%ofth

etotal

capitalvalue

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applicationto

surchargesbe

imposed

when

thecom

missioner

providesapproval

ofsuch

application.T

hebudget

alsoexem

ptsprojects

fundedsolely

bystate

grantsfrom

allCO

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andsurcharges

andauthorizes

DO

Hto

establishcriteria

forthe

purposeof

exempting

certainapplications

fromthe

proposed3%

surcharge.A

dditionally,the

provisionselim

inatea

hospital’sability

todeem

CO

Nfees

andsurcharges

forhospital

constructionapplications

asallow

ablecapital

costsfor

thepurpose

ofdeterm

iningreim

bursement

rates.T

hebudget

estimates

theproposal

will

generatean

estimated

$70m

illionin

staterevenue.

Sexual

assault

forensicexam

inerR

equiresall

hospitalsw

ithem

ergencydepartm

entsto

providecare

tovictim

sofsexual

assault

byhaving

acertified

programsexual

assault

forensicexam

iner(nurse

practitioner,physician

assistant,registered

nurseor

physician)available

onsiteor

within

60m

inutesto

conductan

examand

collectforensic

evidence.H

ospitalsw

ithoutED

5m

usthave

protocolsin

placeto

transferpatients,

with

consent,or

carefor

patientsw

hochoose

notto

transfer,w

hichm

ayinclude

havinga

SAFE

come

tothe

hospital.

Hospital

priceand

qualityA

lthoughnot

explicitlyincluded

inbudget

legislation,the

governorpreviously

announcedan

initiativeto

authorizetransparency

DO

H,

DES

andN

YS

Digital

andM

ediaS

ervicesC

enterto

createa

consumer-friendly

website

(NY

HealthcareC

ompare)

containinginform

ationabout

hospitalcharges

form

edicalservices

andthe

qualityof

servicesprovided.

Additionally,

thesite

would

includeresources

concerningfinancial

assistance

programs

andw

hatto

doabout

asurprise

medical

bill.

21P

age

4HANYS

AlwaysThereforHealthcare

HA

NY

S’D

etailedO

verviewofthe

State

FiscalY

ear2020-2

02

1E

xecutiveB

udget

Issue/topicI

-

Governor’s

budgetproposal

Hospitals

Antim

icrobialresistance

Requires

allhospitals

andnursing

homes

toestablish

antibioticstew

ardshipprogram

sth

atm

eetor

exceedM

edicareand

Medicaid

Conditions

ofP

articipation.A

SPprogram

sm

ustincorporate

anongoing

processto

measure

theim

pactof

theprogram

.A

dditionally,the

budgetrequires

antimicrobial

resistanceand

infectionprevention

trainingprogram

sfor

licensedor

certifiedindividuals

who

providedirect

patientcare.

Hospital

residentcom

plianceaudits

Repeals

provisionsrequiring

DO

Hto

annuallyaudit

hospitalsregarding

theircom

pliancew

ithregulations

governingthe

conditionsand

limits

onthe

number

ofw

orkinghours

forhospital

residents.S

upportingbudget

documents

stateD

OH

will

insteadadm

inistrativelyrequire

hospitalsto

attestannually

totheir

compliance

with

therequirem

ents.C

omprehensive

Psychiatric

Extends

theauthorization

ofC

PEP

untilJuly

20

24

.E

xtendsthe

lengthof

time

aC

PEP

may

holdan

individual,from

Em

ergencyP

rogram72

to96

hours.R

equirestriage

andreferral

servicesto

beprovided

uponreceiving

the

individualinto

theC

PEP.R

equiresadm

issionto

aninpatient

unitif

theindividual

hasbeen

inan

extendedobservation

bedfor

more

than72

hoursand

stillneeds

imm

ediatetreatm

ent

Allow

sfor

theestablishm

entof

CPEP

satellitefacilities.

Rem

oves“crisis

residenceservices”

fromthe

listof

servicesa

CPEP

isrequired

toprovide.

Insurance/managed

careA

dministrative

denialsP

rohibitsan

insurerfrom

administratively

denyingpaym

enttoa

generalhospital

form

edicallynecessary

inp

atient

observationor

emergency

department

servicessolely

onthe

basisth

atth

ehospital

didnot

comply

with

certainadm

inistrativerequirem

ents.T

helanguage

furtherprovides

that

theprohibition

doesnot

applyto

claims

forservices

forw

hicha

requestfor

preauthorizationw

asdenied

bythe

insurer.P

roductidentification

Requires

aninsurerto

identifythe

planor

productofthe

insuredw

hensuch

insurerrequests

additionalinform

ationfrom

aprovider

inorder

todeterm

ineliability

topay

aclaim

.The

budgetalsorequires

aninsurer

toprovide

payment

inth

esecases

within

15days

ofm

akingthe

determination

andto

payinterest

onthe

amountto

bepaid.

Dow

n-codingof

claims

Requires

aninsurer

touse

nationalcoding

guidelinesw

henreview

ing,upon

ahospital’s

request,the

insurer’sinitial

determination

todow

n-codea

claimfor

payment

The

provisionsalso

requirean

insurerto

payinterest

onany

increasedpaym

entresulting

fromth

einform

ationsubm

ittedby

thehospital

relatedto

theinitial

codingofthe

claim.

Adm

inistrativesim

plificationR

equiresD

FSand

DO

Hto

convenea

healthcareadm

inistrativesim

plificationw

orkgroupto

studyand

evaluatew

orkgroupm

echanisms

toreduce

healthcareadm

inistrativecosts

andcom

plexities.Findings

andrecom

mendations

aredue

byA

pril1,

2021.H

ealthcareclaim

spaym

entR

equiresinsurers

toreport

quarterlyand

annuallyto

DFS

onthe

number

andvalue

ofhealthcare

claims,

performance

categorizedby

theclaim

sreceived,

paid,pended

anddenied.

31P

age

I-I

Alw

aysThere

forH

eallhcare

HA

NY

S’D

etailedO

verviewofthe

State

Fiscal Year

20

20

-20

21

Executive

Budget

Issue/topicI

Governor’s

budgetproposal

Insurance/managed

care

Authorizations

forinpatient

Requires

insurersto

make

authorizationdeterm

inationsfor

inpatientrehabilitation

servicesprovided

bya

hospitalrehabilitation

servicesor

skillednursing

facilityw

ithinone

businessday

ofreceiving

necessaryinform

ation.C

urrentprovisions

requiresuch

determinations

tobe

made

within

threebusiness

days.

Tim

eframe

forappeal

determinations

Shortens

thecurrent

timefram

ew

ithinw

hichan

insurerm

ustm

akeappeal

determinations

from60

daysto

30days

ofreceiving

necessaryinform

ation.

Provisionalcredentialing

forR

equirespayers

toprovisionally

credentialphysicians

who

arenew

lylicensed,

haverecently

relocatedto

the

state,physicians

orw

hohave

beenissued

anew

taxidentification

number

toperm

itthem

tobe

reimbursed

forthe

provisionof

servicesto

aplan’s

enrolleespending

thecom

pletionof

theplan’s

credentialingprocess.

Independentdispute

resolutionR

epealsthe

provisionenacted

lastyear

that

exempts

hospitalsw

itha

highpercentage

ofinpatient

Medicaid,

uninsuredor

dualeligible

dischargesfrom

theID

Rprocess.

The

budgetalso

addslanguage

clarifyingth

atinpatient

servicesfollow

ingan

emergency

roomvisit

areincluded

inth

eID

Rprocess.

Hold

harmless

andassignm

entof

Requires

payersto

payout-of-netw

orkproviders

directlyfor

emergency

services,including

anyinpatient

servicesbenefits

following

anem

ergencyroom

visit,w

henan

insuredhas

made

anassignm

entof

benefitto

thenon-participating

physicianor

hospital.T

heprovisions

alsoprohibitthe

non-participatingprovider

frombilling

the

insureddirectly

forth

ose

services,other

thanany

applicablecost-sharing.

Medical

debtR

educesthe

timefram

efor

healthcareproviders

tobring

anaction

tocollect

medical

debtfrom

sixyears

tothree

yearsof

treatment.

Medical

malpractice

Physician

excessm

edicalE

liminates

theexcess

medical

malpractice

programafter

June30,

2020.H

owever,

thebudget

extendsD

ES’m

alpracticeauthority

toset

ratesfor

medical

malpractice

premium

suntil

June30,

2021.T

hebudget

includes$

105

.1m

illionin

funding,a

reductionof

$2

2.3

million

fromlast

year,to

supportthe

costsof th

eprogram

throughJune

20

20

.

Interestrate

oncourtjudgm

entsand

Elim

inatesthe

requirement of

a9%

interestrate

onjudgm

entsand

insteadrequires

interest atthe

“one-yearU

nitedaccrued

claims

States

treasurybill

rate,”defined

asthe

weekly

averageone-year

constantm

aturitytreasury

yield,as

publishedby

theF

ederalR

eserve,for

thecalendar

week

precedingthe

dateof

thejudgm

ent.A

sof

Jan.23,

20

20

theone-year

constantm

aturitytreasury

yieldw

as1.54%

,and

inthe

past12

months

hasranged

from1.5%

to2.6%

.

Medical

indemnity

fundE

liminates

fundingto

supporttheM

edicalIndem

nityFund

forneurologically

impaired

infants.H

owever, th

ebudget

includeslanguage

extendingauthorization

forenhanced

ratesof

providerreim

bursement

untilD

ec.31,

2021.

41P

age

ni

AlwaysThere

forHealthcare

•Issue/topic

)9-

Governor’s

proposedbudget

Workforce

Elim

inationofvarious

workforce

Discontinues

severalhealthcare

workforce-related

programs,

includingthe

Health

Occupation

Developm

entand

programs

Workplace

Dem

onstrationprogram

,w

hichsupports

theadm

inistrationof

theH

ealthW

orkforceR

etrainingInitiative.

The

budgetalso

proposesto

eliminate

severalH

CR

A-funded

workforce

programs,

including:•

Health

Workforce

Retraining

Initiative($9.1

million)

.E

mpire

Clinical

Research

Program

($3.4m

illion).

Am

bulatoryC

areT

rainingprogram

($1.8m

illion).

Diversity

inM

edicineprogram

($1.2m

illion)•

Area

Health

Education

Center

program($1.7

million)

Rural

healthcareaccess

andnetw

orkC

ombines

two

previouslydistinct

programs,

theR

uralH

ealthC

areA

ccessD

evelopment

program($8.25

million)

development

andthe

Rural

Health

Netw

orkD

evelopment

program($5.53

million),

intoone

program.

The

budgetprovides

$9.4m

illionin

supportfor

thecom

binedprogram

,w

hichis

a32%

reductionfrom

lastyear’s

totalfunding.

Doctors

Across

New

York

Maintains

currentfunding

of$9.7

million

tosupportthe

physicianloan

repayment

andphysician

practicesupport

programs.

Registered

pharmacy

techniciansE

xpandsthe

settingsin

which

registeredpharm

acytechnicians

may

practiceto

includecom

munity

pharmacies.

The

proposalw

ouldalso

increaseth

enum

berof

registeredpharm

acytechnicians

fromtw

oto

fourand

thenum

berof

unlicensedpersons

fromfour

tosix

thatm

ayassist

alicensed

pharmacist,

providedth

etotal

number

ofindividuals

undersupervision

doesnot

exceedsix.

Physicianprofile

Modifies

theinform

ationth

atphysicians

must

provideas

partof

theinform

ationm

aintainedon

DO

H’s

physicianprofile

datab

aseand

authorizesthe

useof

aphysician

designeeto

maintain

andupdate

aphysician’s

profile.Physician

oversightand

licensureE

liminates

indefinitelicensure

forphysicians

andrequires

fingerprint-basedcrim

inalhistory

recordchecks

priorto

licensure,M

akesnum

erousm

odificationsto

thecurrent

processgoverning

investigationsof

physicians,physician

assistants

andspecial

assistants

conductedby

theO

fficeof

Professional

Medical

Conduct w

ithinD

OH

.Prevailing

wage

Requires

theprevailing

wage

tobe

paidon

constructionprojects

that

arepaid

forw

ithat

least30%

publicfunds

andw

hosetotal

costsexceed

$5m

illion.T

helanguage

providesspecific

exemption

criteriafor

certaincovered

projects,w

hichw

ouldnot

likelyim

pacthospital

constructionprojects.

The

provisionsalso

establisha

PublicS

ubsidyB

oardw

ithauthority

tom

akebinding

recomm

endationsand

determinations.T

heprovisions

areapplicable

toprocurem

entsissued

orcontracts

executedon

orafter

July1,

2021.E

mployee

sickleave

Requires

allem

ployersto

providesick

leaveto

theirem

ployeeseach

calendaryear.

At

am

inimum

,em

ployeesw

ouldaccrue

onehour

ofsick

leavefor

every30

hoursw

orked,provided

employees

receiveda

minim

umnum

berof

totaldays

ofsick

leaveper

yeardep

enden

tupon

thesize

ofthe

employer.

The

budgetalso

extendscurrent

laborlaw

employee

retaliationprotections

tothis

provision.

SIP

age

ni

Alw

aysThere

forH

ealthcare

—Issue/topic

Governor’s

proposedbudget

——

Workforce

Digital

Marketplace

Establishes

anine-m

ember

Digital

Marketplace

Worker

Classification

Task

Forceto

make

recomm

endations(“gig

economy”)

Worker

concerningth

eem

ployment

ofdigital

marketplace

workers,

includingthe

criteriaused

todeterm

inethe

properC

lassificationT

askForce

classificationof

suchw

orkersand

otherem

ployeeprotections.

The

budgetdefines

“digitalm

arketplacecom

pany”as

anentity

that

operatesa

website

and/o

rsm

artphoneapplication

that

customers

useto

purchaseor

arrangeservices,

includinghealthcare

services.T

heproposal

doesnot

applyto

anycom

panyth

athas

enteredinto

acollectively

negotiatedag

reemen

t

Behavioral

health

Opioids/fentanyl

analogsC

onforms

statelaw

with

federallaw

byadding

24additional

syntheticfentanyl

analogsto

thestate

Schedule

Ilistof

Controlled

Substances

andadds

two

additionalsynthetic

fentanylanalogs

tothe

stateS

cheduleII

listof

Controlled

Substances.

Additionally,

thebudget

authorizesD

OH

toadd

anysu

bstan

ceto

Schedule

Iif

suchsu

bstan

ceis

alreadylisted

onthe

federalschedules

ofcontrolled

substan

ces.

Behavioral

healthparity

compliance

Requires

DO

Hand

DFS,

inconsultation

with

theO

fficeof

Mental

Health

andthe

Office

ofA

ddictionS

ervicesand

Supports,

toprom

ulgateregulations

byO

ct.1,

20

20

establishingbehavioral

healthparity

compliance

programrequirem

entsfor

comm

ercialhealth

insurersand

Medicaid

Managed

Care

plans.R

equiresany

penaltiescollected

tobe

depositedinto

anew

lyestablished

fundth

atm

ayonly

beused

forinitiatives

supportingparity

implem

entationand

enforcement

onbehalf

ofconsum

ers.P

rescription_drugs

Collaborative

drugtherapy

Makes

permanent

provisionsauthorizing

Collaborative

Drug

Therapy

Managem

entand

makes

numerous

managem

entm

odificationsto

permit

PA5

andN

P5to

participatein

CD

TM,

expandthe

permissible

terms

ofthe

collaborativeagreem

ents,expand

thesettings

inw

hichhealthcare

professionalsparticipating

inC

DTM

may

practiceand

modify

thecurrent

requirements

forlicensed

pharmacists

toparticipate

inC

TDM

.P

rescriptionD

rugPricing

andA

uthorizesthe

superintendentof

financialservices

toinvestigate

when

theprice

ofa

prescriptiondrug

hasA

ccountabilityB

oardincreased

more

than100%

overa

12-month

periodand

createsa

nine-mem

berD

rugPricing

andA

ccountabilityB

oardto

aidin

suchinvestigations.

Pharm

acybenefit

manager

Authorizes

DFS

toregulate

PBM

5.T

hebudget

furtherauthorizes

DFS

toestablish

a“code

ofconduct”

forPB

M5

that

may

prohibitconflictsof

interestbetw

eenPB

M5

andhealth

plans,certain

deceptive,anti-com

petitiveor

unfairclaim

spractices,

andpricing

models

suchas

spreadpricing.

Additionally,

the

provisionsrequire

PBM

5to

providespecified

information

toD

FSand

establishesfinancial

penaltiesfor

violationsof

registration/licensureobligations

andfor

failureto

providerequired

information

toD

FS.

61P

age

FAlwaysThere

farH

ealthcareIss’to

pic

Governor’s

proposedbudget

Additional

provisions

DSR

IPw

aiverauthority

Extends

untilA

pril1,

2024,th

eauthority

ofD

OH

,O

MH

,O

PWD

Dand

OA

SAS

tow

aiveany

regulatoryrequirem

entnecessary

toallow

providersinvolved

inD

SRIP

projectsor

replicationor

scalingactivities

toavoid

duplicationof

requirements

andallow

efficientscaling

andreplication

ofD

SRIP

promising

practices.T

hecurrent

authorityto

issueregulatory

waivers

toproviders

participatingin

DSR

IPprojects

isset

toexpire

onM

arch31.

2020.

Tobacco

controlIm

plements

numerous

restrictionsand

protectionsrelated

tothe

useof

tobacco,electronic

cigarettesand

vaporproducts

including,prohibitingthe

saleofflavored

electroniccigarettes

andrelated

products, andthe

saleoftobacco

products,electronic

cigarettesand

relatedproducts

inpharm

acies.A

dditionally,the

budgetauthorizes

DO

Hto

regulatethe

saleand

distributionof

carrieroils;

requiresm

anufacturersof

electroniccigarettes

andvapor

productsto

provideto

DO

Hand

tom

akepublicly

availablecertain

information,

includingingredient

lists;adds

variousother

restrictionsrelating

tothe

sale,display, transportand

advertisingoftobacco,

electroniccigarettes

andvapor

products.

Local

share

ofM

edicaidcosts

Lim

itsthe

county-level(local)

Medicaid

growth

to3%

annually.H

owever,

ifacounty

(includingN

YC)

exceedsits

2%property

taxcap,

Medicaid

spendinggrow

this

limited

to2%

.Ifthe

Medicaid

growth

targetis

exceeded,the

localityis

financiallyresponsible

forthe

excessspending

growth

andrequired

torem

itpaym

entto

thestate

forth

enon-

federalshare

ofthoseexpenditures.

The

languageprovides

theD

ivisionofthe

Budget

with

accessto

relevantdata

toconfirm

,and

ifnecessary,

make

these

financialdeterm

inations.

Health

homes/crim

inalhistory

recordR

emoves

healthhom

esfrom

thelist

ofproviders

that

aresubject

toD

OH

’scrim

inalhistory

recordcheck

processchecks

andauthorized

toclaim

reimbursem

entfor

thecost

ofsuch

process.

Styrofoam

banP

rohibitsth

esale,

useor

distributionof

disposablefood

servicecontainers

made

ofexpanded

polystyrene(Styrofoam

)and

polystyreneloose

fillpackaging

(packingpeanuts)

beginningJan.

1,2022.

Hospitals,

adultcare

facilitiesand

nursinghom

esare

includedin

thedefinition

ofcovered

foodservice

providersincluded

inthis

proposal.T

helanguage

providesspecified

exemptions

tothe

provisionsof

thisproposal

andauthorizes

civilpenalties

forviolations

ofthe

provisions.

EQU

AL

programM

odifiesthe

Enhanced

Quality

ofA

dultLiving

programto

narrowthe

eligibilityfor

fundingto

adultcare

facilitiesw

itha

minim

umthreshold

ofresidents

with

seriousm

entalillness

andto

AC

F5w

iththe

highestpercentage

ofresidents

inreceipt

ofS

upplemental

Security

Income

orsafety

netassistan

ce.F

undingis

authorizedto

supportm

entalhygiene

trainingfor

staff,independent

skillstraining

forresidents

andcapital

improvem

entprojects.

Recreational

marijuana

Legalizes,

regulatesand

taxesadult-use

cannabisfor

individualsover

21years

ofage

andallow

scounties

andcities

with

apopulation

over1

00

,00

0to

optout

ofthe

recreational-useprogram

.T

hebudget

createsthe

Office

of.

Cannabis

Managem

entw

ithinth

eD

ivisionof

Alcohol

Beverage

Control.

Revenues

derivedfrom

theprogram

,anticipated

tototal

$5

00

million

overfiveyears,

will

bedeposited

intoth

eC

annabisR

evenueFund

anddistributed

foradm

inistration,traffic

safetycom

mittee,

socialand

economic

equityplan,

sub

stance

abuseand

prevention.public

healtheducation

andintervention,

researchand

otheridentified

purposes.

@2020

Healthcare

Association

ofN

ewY

orkS

tate

71P

age