Legislature Releases Budget Proposals
Budget negotiations are underway as both houses of the legislature have released their one-house budget bills. These documents delineate the Legislature’s position on Governor Kathy Hochul’s $233 billion budget proposal for 2024, which was unveiled in January.
Primarily focused on fiscal matters rather than policy, these proposals are presented as legislation and are scheduled for a chamber-wide vote later this week. Sources characterize these proposals as symbolic, as a consensus involving the governor and both legislative houses is necessary to finalize the multi-billion-dollar state budget due on April 1.
Below is a brief comparison of the three documents. Bear in mind that these bills are not the final state budget and that the legislature and governor will have to negotiate an agreement where the three bills are not aligned.
HCP Priority Issues at a Glance
10% Medicaid Reimbursement Rate Increase: None of the proposals include increasing Medicaid reimbursement rates by 10%, however, the Senate proposal does call for a 3% across-the-board rate increase.
Oppose $200 Million In Cuts to Medicaid Long Term Care: It is not clear at this time if the unspecified cuts in Medicaid long-term care proposed by the Executive are addressed in either legislative bill. Both houses include funding for various parts of the Medicaid program, but the vague nature of the governor’s proposed cut makes it difficult to determine where or if a restoration is included by the legislature.
Include The Fair Pay Accountability Act (S6963 Rivera / A7335 Paulin) which sets regional hourly reimbursement rates and specifies how those rates will be comprised including direct care-related, operational, and administrative costs. None of the proposals include this language.
Reject Worker Wage Parity Cuts to Consumer Directed Personal Assistance Program (CDPAP): Both houses reject the governor’s proposed cuts.
Reject Part HH: Both houses rejected the governor’s proposals regarding CDPAP which included eliminating conflicts of interest between Licensed Home Care Services Agencies (LHCSA) and Fiscal Intermediaries (FI), eliminating Designated Representatives, and authorizing the Department of Health (DOH) commissioner to make significant changes in the FI marketplace and to make determinations to establish maximum daily and weekly hours that aides may work.
Additionally, none of the proposals include the language of the Home Care Savings and Reinvestment Act (S7800 Rivera / A8470 Paulin) which would repeal Medicaid Managed Long Term Care.
Executive Budget Proposal: Remove CDPAP from Worker Wage Parity (WWP) Requirements
The governor’s proposed budget eliminates WWP for CDPAP workers, decreasing their cash or supplemental benefits and yielding an anticipated $200.4 million in savings to the state for FY 2025 and an additional $400.8 million in FY 2026. HCP opposes this cut.
Senate Budget Bill: Proposal not included in Senate bill.
Assembly Budget Bill: Proposal not included in Assembly bill.
Executive Budget Proposal: New Part HH CDPAP Authorization and Repeal of Designated Representative
The Executive Budget Proposal includes in its amendments a new Part HH regarding the Consumer Directed Personal Assistance Program (CDPAP), which would repeal the fiscal intermediary procurement process and instead replace it with an authorization process, allowing the Department of Health to issue regulations on the authorization process and the program generally, eliminate conflict of interest between fiscal intermediaries, home care agencies, and managed long term care plans, and repeal the “designated representative” provisions from CDPAP. HCP opposes this cut.
Senate Budget Bill: Proposal not included in Senate bill.
Assembly Budget Bill: Proposal not included in Assembly bill.
Executive Budget Proposal: Home Care without Certificate of Need Process
The governor’s 30-day amendments included changes to Part V of the Health and Mental Hygiene Article VII bill that focus on facilitating collaboration between LHCSAs, CHHAs, and agencies, including hospitals, home care agencies, emergency medical services, skilled nursing facilities, and hospices, as well as payors and other interdisciplinary providers, practitioners, and service entities. It allows general hospitals to provide in-home care and medical care services under certain conditions and extends the authorization for mobile integrated and community paramedicine programs. It authorizes the DOH to approve up to 200 new or expanded collaborative programs. Components of the budget proposal incentivize home care workers to move into hospital roles with dual certifications and salary and benefit enhancement. HCP opposes this proposal.
Senate Budget Bill: The Senate rejects the Executive Budget Proposal and instead introduces language to declare general ambulance services as essential, establish special districts for financing and operating these services, and implement a statewide comprehensive emergency medical system plan.
- Assembly Budget Bill: Proposal not included in Assembly bill.OMIG Audit Procedures
The executive budget was silent on addressing provider concerns about the audit procedures of the Office of Medicaid Inspector General (OMIG). HCP has submitted a Memo in Support of the bill included in the Senate budget proposal.
- New Part AAA: The Senate advances language with respect to the OMIG audit procedures and reform practices and standards for the state (S5329 Harckham / A6813 Paulin).Other Proposals of Interest to Home Care
Executive Budget Proposal: Nurse Licensure Compact
The Executive Budget Proposal seeks to increase the number of health care professionals in the state by entering into Interstate Licensure Compacts and nurse licensure compacts that would make it less cumbersome for practitioners with out-of-state licenses to practice in New York, either in person or using telehealth or other virtual technologies.
- Senate Budget Bill: Proposal not included in Senate bill.
- Assembly Budget Bill: Proposal not included in Assembly bill.
New Proposals in Senate Bill:
- New Part PP: Repeals the 30-month look-back period for Medicaid eligibility for home care services.
- New Part QQ: Establishes the Office of Hospice and Palliative Care Access within the Department of Health.
- New Part RR: Proposes a uniform rate increase of 3% for Medicaid payments. Additionally, proposes a 7% rate increase for hospitals and a 6.5% rate increase for nursing homes, assisted living programs, and hospices.
HCP Support
HCP’s Public Policy Team, including contract lobbyists Reid, McNally, and Savage, will continue to analyze the one-house bills and bring you updates as they are available. Stay tuned to HCP channels for breaking news and Take Action Alerts.