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HPCANYS Brings Budget Priorities to Lawmakers (Feb. 8, 2019)
02/08/2019

Merikokeb Wondafrash
Session has definitely kicked off with a bang. From what I have read,  landmark legislation  has been introduced, passed and signed on women's rights and child victim's advocacy... and they have only just begun!
Lobby Day for HPCANYS coincided with the joint Legislative Hearing on Budget which made for a busy day. Representatives from a number of programs across the state came to Lobby day and spoke with their legislators. They shared patient stories showing the good work that they do, shared about challenges they face in operating a hospice and what the legislature can do to help. The talking points are available on our website. These are the same points made in the budget testimony below, just packaged in a slightly different order.
 
As is the normal process, the Governor has submitted his Executive Budget- as both a way to set policy as well as the budget. We requested to testify but were not chosen. But we did submit to the committee written testimony related to hospice and palliative care to the Joint Legislative Hearing on the Budget for Health. It revolved around the following issues:


The items that we would like changed in the budget are as follows:
 

Criminal History Record Check Funding/Reimbursement: Effective April 1, 2018, hospice workers who provide direct care or supervision of patients became subject to a criminal history record check (CHRC) as a condition of employment and hospices were also added to the list of providers that would be reimbursed for the additional cost associated with this requirement. DOH has not created a mechanism for hospices to be reimbursed for this mandated cost. Reimbursement must not be an addition to the Medicaid rate because of the minimal Medicaid hospice volume.
OUR ASK: The legislature direct DOH to create a mechanism for payment of these funds to hospice programs, and require payment of funds to all eligible provides within 45 days of receipt and approval of the invoice.

Health Care Facility Transformation Programs Funds:The Executive Budget proposes an allocation of up to $300 million of the $525 million from SFY 2018-2019 funds to fund applications which were already submitted - but not granted- under Phase II of the program. Hospice organizations were not included in Phase I or II but are now included in Phase III. Transferring Phase III money will decrease the ability of the hospices, in great need of facility transformation money, to access those funds.
OUR ASK: Programs that were not allowed to apply in Phase II receive preference for selection in Phase III. 


The items that we want added to the budget are as follows:


Advance Care Planning: Last year, in his State of the State message, Governor Cuomo pledged to initiate a statewide ACP campaign, to include public outreach and education, engagement and encouragement of New Yorkers of all ages to complete ACP documents. We support empowering the public with the knowledge, so that they can choose what is right for them.
OUR ASK: The State of NY fund a public education ACP campaign for $5 Million over the next 2 years.
 
Emergency Medicaid Payment for Hospice: New York State's Medicaid for the Treatment of an Emergency Medical Condition helps eligible, undocumented and temporary immigrant New Yorkers pay for medical costs when an individual needs immediate medical attention for a serious health issue. As hospice is not a covered service, the only option available for an individual eligible for Emergency Medicaid who is terminally ill would be in a hospital setting, rather than at home or in a hospice residence, which are more appropriate and preferable settings.
OUR ASK: Include Hospice Care as an approved reason for Emergency Medicaid Payment.
 
Access to Palliative Care for All New Yorkers: Research has shown that palliative care improves patient satisfaction and clinical outcomes. California is the only state with an approved and funded Palliative Care Benefit.
OUR ASK: Conform the definition of palliative care throughout New York statues and fund a study to create a palliative care benefit and payment structure for Medicaid recipients.
 
Medicaid Managed Long Term Care and Hospice: Patients enrolled in hospice cannot access services of MLTCP without first dis-enrolling from hospice. This process can take up to 6 weeks. During this time, patients are left without hospice care or MLTCP services.
OUR ASK: That the state remove this barrier through plan redesign/ waiver and allow individuals eligible for MLTCP who enroll in hospice first to be able to enroll in MLTCP without dis-enrolling from hospice.
In addition to our budget requests, we are watching all bills that are submitted to see if there is any implication for HPCANYS members.
  • MAID- In January, A02694 was submitted by Assembly Member Paulin, aka the Medical Aid in Dying Bill. This was updated from the 2018 session. Important to note, is that now there is language in this bill which would 'require the physician to offer to make a hospice or palliative care consultation' during the process of approval for MAID.
  • WORKFORCE- We are also keeping a close eye on bills that would support the health care workforce.
  • BUDGET SHORTFALL- There is no word yet on how the state is going to make up the shortfall announced this week of $2.3 Billion. The Governor is attributing this to a sharp drop in income tax collections in December and January. This shortfall is the most significant in 8 years and is being tied to New Yorkers leaving NY or changing their primary residence to out of state.