Governor Cuomo Unveils State of the State Agenda

Lauren Pollow in Legislative

This afternoon Governor Andrew M. Cuomo unveiled his 2018 State of the State agenda to begin the Legislative Session. Governor Cuomo’s agenda contains a long list of policies including efforts to mitigate the impact of federal tax reform, manage ongoing infrastructure issues, combat sexual harassment, continue economic development, and remain a “beacon for social progress”. While the budget gap exceeds $4 billion with an additional $2 billion cut in Federal aid, the Governor has laid out an ambitious agenda during the final State of the State of his second term.

While few detailed proposals are unveiled during the State of the State, the Governor briefly discussed a commitment to preserve Medicaid and the Children’s Health Insurance Program (CHIP). “In New York, healthcare is not just for the rich, it’s a human right” and later indicating “we’re going to protect it.” Only one health care initiative was mentioned in the presentation, joined by two additional proposals outlined in the briefing book as follows:

Vital Brooklyn Initiative: The Executive proposes $1.4 billion to transform Central Brooklyn and serve as a national model for high-need communities. This initiative will target and invest in eight integrated areas to improve chronic health disparities and address social determinants of health. This will be accomplished by increasing access to health food, preventative care, and affordable housing in Brooklyn, New York.

Expanding Telehealth Services: The Governor has proposed expanding access to telemedicine, citing challenges for rural New Yorkers and ongoing provider shortages. The Governor seeks to modernize telehealth by ensuring telehealth services are covered in more settings under Medicaid. Under the Governor’s proposal, qualifying individuals will be able to receive telehealth services wherever they are located, including their own home. His proposal includes a pilot program to address rural resource constraints that prevent appropriate IT investment for providers.

Community Paramedicine: The Governor proposes to address issues facing rural emergency medical technicians (EMT) agencies through recruitment, retention, and strengthening of the system across New York State. In the proposal, the Department of Health (DOH) will launch a coordinated media and educational campaign to heighten awareness of EMS employment opportunities. Additionally, DOH will be proposing a Community Paramedicine collaborative to expand the scope of services carried out by emergency medical technicians (EMTs).

With respect to the Republican tax legislation, the Governor referred to the bill as “an assault on New York” and will be filing a lawsuit to challenge the legality of the law on an equal protection basis. The Governor proposes to change the State’s income and payroll tax system, include new opportunities for charitable contributions, and is contemplating an end to the carried interest loophole.

The Governor’s Executive Budget Proposal is due by January 17th and NYSHFA/NYSCAL will be sending out detailed information on the proposals impacting the delivery of long-term care as they become available.

NYSHFA/NYSCAL CONTACT:

Lauren E. Pollow
Director of Government Affairs
518-462-4800 x25

Governor Vetoes Bill Restoring Bed Hold Cut

Lauren Pollow in Legislative

As you are aware, NYSHFA/NYSCAL has been advocating for the passage of legislation in response to the repeal of the State’s Medicaid reserved day reimbursement for skilled nursing facilities. On December 18, 2017, the Governor made the decision to veto this bill. Please see below for details and next steps resulting from this decision:

Governor Vetoes Bill Restoring Bed Hold Cut

As part of the 2017-18 Enacted Budget, the Governor repealed the State’s Medicaid reserved bed day reimbursement (“bed hold”) to skilled nursing facilities, with a goal of saving $18 million annually. Once implemented, skilled nursing facilities with 95% census or higher would no longer receive 50% Medicaid payment for holding a resident’s bed for a hospitalization, but would still be required to hold the bed for 14 days annually (therapeutic leave of absence not impacted by the state budget and amended Public Health Law).

In response to advocacy efforts from NYSHFA/NYSCAL and our partner associations, the Department of Health (DOH) issued a Dear Administrator Letter (DAL) on May 13, 2017 advising providers that the implementation of the amended law would be delayed until there are corresponding regulations that can be enacted.

Following the DAL, a bill was introduced in early June and passed unanimously in both houses to fully restore the 2017-18 Budget bed hold cuts by way of legislation. A.8338 (Gottfried)/S.6559 (Hannon) was delivered to the Governor on December 6th, 2017.

On December 18, 2017, the Governor vetoed the bill, which would have restored the bed hold cuts removed by the 2017-18 Budget. In his veto message (#238) the Governor stated that while he supports the objective of the bill, it is not supported by an “identifiable funding source” and as such, stated that the issue must be addressed in the context of the annual budget negotiations. NYSHFA/NYSCAL will continue to push for this legislation to be included in the upcoming budget and will stay opposed to the Governor’s proposed requirement that providers must hold the same room, same bed for 14 days with no payment. We thank our many members that acted and contacted the Governor’s office on this issue. NYSHFA/NYSCAL has several avenues to pursue legislative action that will resolve the issue or reach a compromise during the 2018 session.

Veto message can be viewed here.

NYSHFA CONTACT:

Lauren Pollow
Director, Government Affairs
518-462-4800 x25

Affordable Care Act (ACA) Repeal and Replace Defeated

Lauren Pollow and Stephen B. Hanse in Legislative

The scaled-down GOP plan to repeal sections of the ACA has been rejected, with Senator John McCain casting the deciding vote (49-to-51). While the “skinny repeal” was a scaled-down version of the original bill, the impact to health care in terms of affordability and access would have been sweeping. In addition to a repeal and replace, Senate leadership attempted to fundamentally overhaul Medicaid with spending cuts totaling $772 billion over 10 years, covering an estimated 15 million less individuals.

AHCA issued the following statement on the final vote: 

REPEAL AND REPLACE DEFEATED

If you were up late last night watching the Senate, you witnessed one of the most dramatic few hours in Senate history. Three Republicans - Lisa Murkowski (AK), Susan Collins (ME), and John McCain (AZ) - voted against the "skinny repeal," joining with all 48 Democrats to defeat the legislation.

There were 51 "no" votes, but all the drama centered on one person - Senator McCain. Less than two weeks out from brain surgery, he not only made the long trek from Arizona, but he also worked through the 16 hours of Senate action on Thursday and early Friday morning leading up to the final vote. He had made noise about possibly voting against skinny repeal all day, but most seasoned watchers believed he would eventually come around. Those that stayed up witnessed Vice President Mike Pence on the floor of the Senate urging him on. But it was to no avail. In one of the most dramatic moments in Senate history, McCain voted no and cemented his legacy as the maverick senator from Arizona. 

It is too early to know what this means for repeal and replace in the long run. In the short term, this debate is over. The House of Representatives leaves today for the August recess. The Senate stays for two weeks to work on other matters. It is very unlikely that there will be much - if any - action on health care for the next few weeks.

What happens in the intermediate and long term will depend on the public. Many Republicans believe and hope that voters will express their anger in the August recess and force action in the fall. Many Democrats believe the opposite will occur. They believe the public will reward those that kept repeal from happening and will be happy that this is over. What happens in town halls across the country in August will matter.

AHCA will closely monitor all developments. We need to thank those that helped us in the Medicaid fight. It is also important to reflect on our interactions with those that did not. Nothing needs to happen today or over the next few days. Everyone involved in the process needs to take a deep breath and absorb all that has happened over the last few months.

But what I want to do with no hesitation, right now, is thank you. Our members from every corner of the country have stepped up to defend our sector and, more important, to defend our residents. There was no need for Medicaid reform to be a part of this, and if it hadn't been, I think we would have stood down on this issue. But policymakers decided that we were not only going to be a pay-for when Congress enacted the Affordable Care Act (ACA), but we were also going to be a pay for when Congress repealed it - and you refused to accept that. Collectively, we had hundreds of meetings, thousands of phone calls, and over 100,000 emails defending our residents. In the end, our long term personal relationships are what mattered the most.

It's been a roller coaster ride, and although it feels like it is over this morning, it's not. Our battle never ends. But our persistence will never end either. They throw everything they have at us, and we just keep going and going. Thanks so much for the honor to work for you, and more important, the honor to work for all of your residents. I know it is incredibly tough right now, but we are going to make it through these challenging times.

Sincerely,

Mark Parkinson
President and CEO

NYSHFA/NYSCAL CONTACTS:

Lauren Pollow
Director, Government Affairs
518-462-4800 x25

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11

Affordable Care Act (ACA) Repeal and Replace Update

Lauren Pollow and Stephen B. Hanse in Legislative

On July 25, 2017 the Senate voted to debate a repeal and replace of the ACA, which Senate Majority Leader Mitch McConnell achieved by a narrow margin (more below from AHCA). The vote to proceed was split 50 to 50 with Vice President Pence casting the deciding vote.

There will now be 20 hours of debate during which amendments can be introduced and voted on. Importantly, the Better Care Reconciliation Act of 2017 (BCRA), the amendment containing the most harmful Medicaid cuts for long-term care providers, failed to pass last evening. *Please note that this is a change from the AHCA bulletin represented below.

AHCA and NYSHFA will continue to provide daily updates as the vote moves forward. Members are expected to return today at 11:30 AM and we anticipate that amendments will be introduced by both parties until there is a final bill. At this time, we expect this process to conclude on Friday.

Please see the overview from AHCA below for more information:

THE SENATE SECURED THE VOTES TO DEBATE THE BILL

A threshold question was whether the Senate could even debate the bill. For that to happen, Senate Majority Leader Mitch McConnell needed 50 of his 52 Republican colleagues to vote yes. That is exactly the number he received. Senator John McCain (Arizona) made a dramatic and heroic entrance and provided the final vote needed for that motion. But there was much more to Senator McCain's entrance than just his vote. He then spoke on the bill and indicated that he just wanted to open debate, but ultimately he would join the list of four other Republican senators and vote against the BCRA when the final vote takes place.

THE SENATE IS NOW DEBATING A STRAIGHT REPEAL

To get their votes on the motion to proceed, Leader McConnell promised Senator Rand Paul (Kentucky) and other conservatives that the first amendment the Senate would take up will be a clean repeal of the Affordable Care Act (ACA). Specifically, the amendment is the 2015 language that both the House and Senate passed and that President Obama vetoed.

This is likely to fail. It requires 50 votes, but already, four Republicans have indicated they will vote no - and I suspect three or four more will join them.

AFTER THAT THE SENATE IS LIKELY TO CONSIDER THE BCRA *(See Edit Above)

The current plan is that if the straight repeal fails, the next amendment for consideration will be the BCRA. Again, this is the version that contains the two provisions that hurt us. It lowers the growth of the per capita cap to CPI Urban, and it restricts provider assessments to only 5 percent. The most important part of this entire debate is that we need this amendment to fail.

We currently believe that it will fail. The following Republican senators have indicated opposition to it: Paul, Lee (Utah), Moran (Kansas), Collins (Maine), and now McCain. Others that may vote against include Capito (West Virginia), Murkowski (Alaska), and Heller (Nevada). There could be others. To fail, we need just three no votes, and we have pretty good confidence in the five publicly-stated above and some confidence in at least two or three more.

THEN WHAT? SKINNY REPEAL?

Assuming those two major amendments fail, the House Bill is left. It does not touch provider assessments and has a slightly more generous growth rate. But it won't pass. There are even more no votes in the Senate on the House Bill than the two prior discussed amendments.

The current discussion is that Leadership will then offer a "skinny" version of an ACA repeal. It may just include a repeal of the individual and employer mandates. It is not at all clear if that would pass. If it does not pass, that is the likely end of this round of the repeal and replace attempts. If it does pass, then the House could either take it to conference or just vote on it without going to conference. A conference committee would give us the chance to demand that the House stand firm in its growth rates. Even better would be a straight House vote. That would be better because this "skinny" repeal will likely have no changes to traditional Medicaid.

THE BOTTOM LINE

This still very fluid. The process is likely to take from now until early Friday morning. In the meantime, we will continue our lobbying efforts, particularly focusing on those that have committed to help us or are on the fence.

We will update you any time there is key information or when we think you could be receiving misinformation from the press.

The current state is that we face an enormous risk but have the votes to succeed. We will continue to do everything we can to end up with that result.

WHAT YOU CAN DO

You can help. I've said this many times. The Affordable Care Act repeal and replace effort is the biggest threat we have faced to Medicaid in the history of our sector. The 100,000-plus contacts we have made thus far have made a difference, and we cannot let up. We must keep fighting to protect the millions of patients and residents who depend on Medicaid for long term care.

Call every Senate and House Republican that you have any connection to and use the state-specific talking points to explain the devastating impacts proposed Medicaid cuts in the BCRA would have. You can register for our online grassroots Care Advocacy resource to easily locate and contact them.

We appreciate everything you do.

Sincerely,

Mark Parkinson
President and CEO

NYSHFA CONTACTS:

Lauren Pollow
Director, Government Affairs
518-462-4800 x25

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11

Senator Jeff Klein to Speak at 2016 NYSHFA/NYSCAL Convention

Esq. Stephen B. Hanse in Legislative

New York State Senate Coalition Co-Leader and Senate Independent Democratic Conference Leader Jeff Klein (Bronx, Westchester) will address attendees at 9:15 am on Wednesday, June 29th at the 2016 NYSHFA/NYSCAL Annual Convention at the Sagamore Resort in Bolton Landing.

A steadfast leader on issues affecting skilled nursing and assisted living providers throughout New York, Senator Klein was first elected to the State Senate in 2004 and has more than two decades experience in politics, law and public service.

Senator Klein holds a B.A. from Queens College, an M.P.A. from Columbia University's School of International and Public Affairs and a J.D. from the City University of New York Law School. Senator Klein previously served as Senate President Pro Tempore from 2012-2014 and also served as Deputy Majority Leader of the Senate from 2009-2010. Prior to that, Senator Klein served his current district as a member of the New York State Assembly for ten years.

Joining Senator Klein at the 2016 NYSHFA/NYSCAL Annual Convention will be Senator Diane Savino (Staten Island, Brooklyn).

NYSHFA CONTACT:

Stephen B. Hanse
VP & Counsel
518-462-4800 x25

Senate Passes "Doc Fix"/Extends Part B Therapy Exceptions

Esq. Stephen B. Hanse and Carl J. Pucci in Legislative

Last night the Senate passed the sustainable growth rate (SGR) legislation, sending the bill to the President for his expected signature.  The SGR, in addition to a permanent “Doc Fix”, extends the therapy cap exceptions process for 33 months (through 12/31/17), as well as implements AHCA’s proposed therapy review process.  The Therapy Cap of $1,940 for Part B services remains unchanged going forward.

Please see attached AHCA bulletin for complete details.

NYSHFA CONTACTS:

Stephen B. Hanse, Esq.
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36

State of the State/2015-16 Budget Presentation

Esq. Stephen B. Hanse in Legislative

Governor Cuomo delivered his fifth State of the State today at the Empire State Convention Center in Albany, and in a joint presentation, simultaneously unveiled his 2015-16 Executive Budget.

As presented, the 2015-16 Executive Budget increases overall State spending by 1.7 percent, an increase of $1.6 billion, and provides for a 3.6 percent growth in Medicaid spending, an increase of $597 million. The Executive Budget also proposes to limit state agency spending increases to 0.6 percent. In addition, the Governor’s Executive Budget proposes to allocate the $5.4 billion surplus as follows:

  • $850 million for reimbursing the federal government for OPWDD billing discrepancies;
  • $1.5 billion for upstate revitalization initiatives; and
  • $3.05 billion for the implementation of various infrastructure and economic development initiatives, including the proposals set forth below.


In speaking for almost two hours, Governor Cuomo laid the groundwork for various initiatives he has planned for the 2015 Legislative Session. Among other things, the Governor advanced the following proposals:

  • Increase the statewide minimum wage to $10.50 by the end of 2016 and raising the City’s minimum wage to $11.50;
  • Provide $1.3 billion to the Thruway Authority to help prevent toll hikes for 2015 and offset the cost of replacing the Tappan Zee bridge;
  • Reduce property taxes statewide by $1.7 billion;
  • Add 100 charter schools to the statewide cap;
  • Provide $500 million (with a $500 million private sector match) to expand broadband internet infrastructure in rural areas of the State;
  • Provide $750 million to the Department of Transportation to invest in road and bridge repair initiatives;
  • Provide tuition assistance for the children of undocumented aliens (“Dream Act”);
  • Establish an education tax credit for those who donate money to schools;
  • Implement a 10-point women’s equality agenda; and
  • Institute certain campaign finance reform initiatives.


It is anticipated that there will be changes made to the proposed Executive Budget set forth in the Governor’s 21-day and 30-day budget amendments. It is further anticipated that the Senate and the Assembly will release their respective budget resolutions in early March and the 2015-16 State Budget will be completed by April 1st.

We will provide further details as soon as the budget bills are introduced.

NYSHFA CONTACT:

Stephen B. Hanse, Esq.
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

Save the Date - 2015 NYSHFA Legislative Visitation Day

Esq. Stephen B. Hanse in Legislative

NYSHFA will be holding a Legislative Visitation Day on Monday, March 2nd in Albany to meet with key elected officials and policymakers regarding issues and concerns related to the 2015-2016 Executive Budget (the Governor is presenting the Executive Budget on Wednesday, January 21st).

We will start the day on March 2nd in the Legislative Office Building with a light breakfast and then divide into groups for meetings with legislators and policymakers.  All meetings will be arranged by NYSHFA and we will e-mail concise issue briefs and meeting schedules to each participant prior to their arrival in Albany.  NYSHFA will also hold a conference call approximately one week prior to our Albany visitation day to review discussion issues and meeting logistics.

In addition, we will be holding a fundraiser dinner the evening before our Legislative Visitation Day on Sunday, March 1st – details to follow.

A block of hotel rooms has been set aside at the Hilton Albany, 40 Lodge Street, Albany, New York for the night of Sunday, March 1, 2015.  To book a room, please call the Hilton Albany directly at 1-866-691-1183.  We have a rate of $149.00 (standard guest room).  The group Code is 1NYSHF.  Also, the discounted parking rate is $8.00.  The cutoff date for reservations is February 6, 2015.

Please contact Nancy Knapp at nknapp@nyshfa.org at your earliest convenience if you plan on attending the March 1st evening fundraiser and the NYSHFA legislative visitation day on Monday, March 2nd.

NYSHFA CONTACT:

Stephen B. Hanse, Esq.
Vice President & Counsel, Governmental Affairs
518-462-4800 x25

2014-15 Executive Budget Summary

Esq. Stephen B. Hanse and Carl J. Pucci in Legislative

Governor Cuomo unveiled his 2014-15 Executive Budget today. The following is a brief summary of certain initiatives affecting skilled nursing and assisted living providers included within the Governor’s the Health and Mental Hygiene Article VII budget bill.  NYSHFA/NYSCAL will follow up with a more detailed discussion of these and other provisions included within the Executive Budget.

Specifically, the Governor’s 2014-15 Executive Budget proposes to...