|
|
“We must fundamentally
rethink the way health care is delivered in New York State so that
we can both improve quality and contain costs. It won’t be done
overnight - and it will take sacrifice and innovation - but that’s
never stopped New Yorkers before.” However, first we wanted
to share that Weingarten, Reid & McNally (WRM) has attended a
number of MSSNY meetings on behalf of New York ACEP to continue to
press our concerns over legislation or regulatory action which would
require default rates for emergency services. WRM shared with MSSNY
two documents outlining this issue and one detailing other New York
ACEP priorities such as overcrowding and no-fault coverage for 2007
(see below). OUTLOOK FOR 2007 The Governor-Elect has until
February 1st to submit a proposed budget to the State Legislature.
Eliot Spitzer has vowed to make “honest and hard choices to reduce
the cost of health care and increase access to health insurance”.
Noting that Medicaid is the largest and fastest growing part of the
State budget, Spitzer has said that it “must be part of comprehensive
reform.” On his campaign website
www.spitzerpaterson.com, Governor-Elect Spitzer has layed out his
plan to reform the way that health care is delivered in New York State: Increase access Increase affordability
and cost control while maintaining quality Reduce the cost of Medicaid If we are ever going to
bring meaningful health care reform, we must increase the state’s
ability to investigate and prosecute Medicaid fraud by expanding the
tools available to the state. We must also reduce Medicaid’s
prescription drug costs through a stronger preferred drug list program.
A focus in Spitzer’s
health care plan, fraud and abuse is an area that will gain momentum
in 2007. It was a centerpiece of the 2006 budget following a three-part
story in the New York Times on Medicaid fraud. An agreement was reached
in the final days of the 2006 session between the Governor and the
Legislature to establish in law a new independent Office of Medicaid
Inspector General (MIG) who will serve at the pleasure of the governor.
The bill provides broad powers to the MIG to investigate potential
fraud, abuse and waste, and increases civil and criminal penalties
for Medicaid fraud. It limits the application of “health care
fraud” crimes to those situations where a health care provider
has “knowingly and willingly” submitted false claims. It
requires health care providers to implement corporate compliance programs
to combat fraud. As Attorney General, Eliot Spitzer was very vocal
and involved in fraud and abuse cases. He is expected to use this
new office to significantly step up state government’s efforts
in this area. Next year will be a time
of great change in Albany. In addition to the elections, top level
policy positions at nearly every state agency are likely to change.
WRM will keep New York ACEP members apprised of developments that
will affect access to emergency health care in New York State. Volunteer Physician Legislation Physician Shortage Study
Bill Health Plan Reforms
Timothy’s Law Increase in DWI Penalties Vaccinations Bill Immunizations Registry
Bill Summary of Concerns Regarding
Default Rates for Emergency Services
Key Legislative Priorities
for 2007 Support legislation and
other measures to address problems associated with Hospital Crowding
and Ambulance Diversion In some institutions the
situation has reached crisis proportions. Due to capacity and resource
constraints within hospitals, care is delayed for waiting patients
or patients are diverted to other hospitals, requiring travel at significant
distances in an emergency. Additionally, patients who have been seen
and treated in the emergency department (ED) and admitted to the hospital
are sometimes boarded in hallways for inordinate amounts of time without
comforts like a bathroom, mattress, call light, privacy or confidentiality
while awaiting inpatient beds. New York ACEP supports legislation
which codifies into law the Department of Health’s guidelines
on hospital crowding and ambulance diversion and creates new mechanisms
to implement and enforce these directives, including unannounced annual
inspections by the Department and a requirement that hospitals report
over six diversions in a month or over twenty-five in a year to the
Department. New York ACEP supports universal access to high quality
emergency care for any person who believes that he or she needs emergency
services. Oppose legislation to
reduce reimbursement for emergency services for non-participating
providers in commercial and government managed care plans Reduced access to on-call
specialists results in significant delays for patients awaiting care
and increases the number of patients that must be transferred to obtain
the required services. We are particularly concerned that a prohibition
on balance billing of emergency services would further reduce patient
access to on-call specialists in hospital emergency departments. An
unintended effect of the legislation could be to force specialists
to make an unpalatable choice of either absorbing further financial
losses by accepting inadequate government and commercial insurance
rates or further reducing their coverage at hospitals. New York ACEP opposes any
proposal to prohibit balance billing of emergency services or require
nonparticipating providers to accept, as payment in full, the “usual
and customary” fees of commercial managed care plans for emergency
services provided to the managed care plans’ enrollees. Support legislation to
require No Fault Insurance Coverage of Emergency Treatment With the exorbitant cost
of treating a person for injuries from alcohol-related crashes, health
care providers, such as emergency physicians, can no longer bear the
burden of these costs. Legislation passed both houses last year to
correct this inequity by ensuring that health care providers receive
proper compensation for the medical treatment they provide. Unfortunately,
the bill was vetoed by Governor Pataki. New York ACEP supports the introduction and passage of legislation in 2007 to ensure that payments are made by motor vehicle insurance carriers to physicians and other health care providers for the treatment of injuries to an intoxicated driver. New York ACEP Scores
Major Victory: Medicaid Fee Increase Provided below is a summary
of budget highlights and other legislation of interest to New York
ACEP Medicaid Inspector General An agreement was reached
in the final days of the Session between the Governor and the Legislature
to establish in law a MIG who will serve at the pleasure of the Governor.
The bill provides broad powers to the MIG to investigate potential
fraud, abuse and waste, and increases civil and criminal penalties
for Medicaid fraud. The language of the bill limits the application
of “health care fraud” crimes to those situations where
a health care provider has “knowingly and willingly” submitted
false claims. The final agreement does not allow individuals to bring
private lawsuits— something that the Assembly sought but the
Senate rejected. The bill requires health care providers to implement
corporate compliance programs to combat fraud. Balance Billing Prohibition In addition, Dr. Sama, Dr.
Murphy and Bob Reid attended a June 15th meeting with the State Superintendent
of Insurance, Howard Mills, to make him personally aware of the issue
and the consequences of imposing a limitation. New York ACEP members
made the argument to the Superintendent that a balance billing prohibition
would hurt access to patient care by exacerbating the problems of
reduced on-call specialty coverage and hospital crowding. New York
ACEP and Weingarten, Reid & McNally will continue to monitor this
issue and fight any further attempts to impose fee limitations for
emergency services. Patient Access Legislation New York ACEP members Dr.
Samuel Bosco and Dr. Mara McErlean joined Weingarten, Reid & McNally
at a March 20th meeting with David Wollner, Director of the Office
of Health Systems Management for the New York State Department of
Health (DOH), and several of Mr. Wollner’s staff members. During
the meeting, the findings of New York ACEP’s recent survey were
discussed as well as possible options to reduce hospital crowding
and ambulance diversion. In the Chapter’s most recent survey,
93% of respondents reported crowding as a problem, with 59% citing
it as a year round issue. Department of Health officials
acknowledged the widespread, multi-faceted problem of crowding in
New York’s hospitals and agreed to continue to work with New
York ACEP to address it. New York ACEP proposed additional spot checks
by the State DOH during peak hours as one step that could be taken
to improve compliance with the Commissioner’s directive to “use
all available inpatient beds in managing admissions from the emergency
department.” In addition, New York ACEP recommended the collection
of data during evening hours when crowding and boarding of patients
in the ED is most prevalent. Currently, data is provided by hospitals
to State DOH mid-week in the morning. Although we were unable
to achieve a consensus within the State Health Department and the
Legislature on our recommendations, the lobby day and meetings with
State officials were a great success in raising awareness and understanding
of this difficult issue among legislators and State DOH staff. In
the coming year, New York ACEP will continue to work toward a solution.
Emergency Services for
Children Legislation
This bill, if signed by
the Governor, will be effective immediately. Due to this bill’s
overwhelming support from the medical and trauma services community,
it is anticipated that the Governor will sign this legislation. Regressive Medical Liability
Legislation Defeated The first bill, S.36 (DeFrancisco)
would have removed the current statutory limit on the fees attorneys
can take in medical liability actions. The second bill, S.54 (DeFrancisco),
would have expanded the damages awardable in a wrongful death action.
The identical bill (A.5856, Weinstein) was reported by the Assembly
Judiciary Committee to the Assembly Codes Committee. Increase in DWI Penalties We would like to thank New York ACEP members for your strong grassroots advocacy efforts this year. As the New York ACEP newsletter
goes to print, the acrimony in Albany is at an all-time high. As expected,
the State Legislature passed an “on-time” State Budget before
the April 1st deadline, for the second year in a row after twenty
years of late budgets. The $112.8 billion “two-house” budget
deal was negotiated and passed without the involvement of Governor
Pataki, who spent almost two months recovering in hospitals and at
home from emergency surgery for an appendectomy. Upon his return to
Albany just prior to the spring recess, Governor Pataki vetoed 207
items totaling over $2.9 billion. In issuing his vetoes, the Governor
greatly raised the stakes by declaring much of the Legislature’s
budget increases to be unconstitutional under the terms of the recent
Court of Appeals case (Silver v. Pataki). During the last week of
April, the Senate and Assembly successfully overrode all of the Governor’s
vetoes, although Governor Pataki has said that he will not enforce
unconstitutional overrides. Both Senate Republican Majority Leader
Joseph Bruno and Assembly Speaker Sheldon Silver have accused Governor
Pataki of negotiating in “bad faith” and say that they will
take the issue to court if the Governor follows through on his threat
to withhold funds. Unless all three sides can come to a new three-way
agreement, billions of dollars, including almost $1 billion in health
care, will be impounded by Governor Pataki while the disagreement
over budget powers once again heads to the Judicial Branch. Legislature Increases
Medicaid Reimbursement Fee for Emergency Physicians Unfortunately in mid-April,
Governor Pataki vetoed this fee increase, claiming that it was unconstitutionally
submitted by the Legislature. Immediately following the Governor’s
veto, New York ACEP again mobilized its grassroots network and was
successful with the Legislature overriding this veto. However as previously
stated, the Governor has declared that he will ignore the Legislature’s
overrides in the area of Medicaid, Family Health Plus and others which
he views to be unconstitutional. Governor Pataki’s hard
line on impounding hundreds of millions in health care funds and $805
million in property tax rebates leaves legislators who are running
for re-election this fall with the limited options of either heading
to court or renegotiating a whole new deal in order to shake loose
the funds. Of course this doesn’t provide much solace because
the court route spells nothing short term and the renegotiation route
would put us in a very competitive situation vis-à-vis other
appropriations. Weingarten, Reid & McNally will continue to monitor
the situation on the ground in Albany and will continue to work with
the Chapter office on public relations, advocacy and other strategies
to fight for the much-deserved Medicaid fee increase for Emergency
Physicians. Medicaid Inspector General Despite bi-partisan support
for the MIG, the Legislature was unable to reach agreement on the
details of the proposal. Outstanding issues include the length of
time of the Inspector General’s term, the severity of the penalties,
and how much authority should be given to county government to pursue
provider fraud. The Governor’s bill proposes a five year term
for the MIG, who would be appointed by Governor Pataki this year.
The Democratic Assembly is unwilling to accept a Republican MIG for
such a long period of time. Despite these differences, negotiations
on this issue are continuing in earnest. Legislators would like to
claim victory for a Medicaid fraud and abuse initiative as they head
toward the November elections. In addition, the Legislature’s
two- way budget agreement assumes that $475 million will be saved
through the establishment of a Medicaid Inspector General and other
anti-fraud and abuse proposals. New York ACEP 2006 Lobby
Day The lobby day was a great
success in raising awareness on New York ACEP’s legislative goals
and fostering relationships with key policymakers. In fact, the timing
was optimal, as the Legislature was negotiating emergency department
fee increases while Board members were in Albany and we were able
to ensure that a fee increase for emergency physicians was included
in the discussions. Patient Access Legislation End of Session Outlook New York
ACEP Collaborates with National to Release New York’s Report
Card
The above quotes appeared
in articles from newspapers across the state as well as web-based
media highlighting the findings of New York’s Report Card. Weingarten,
Reid & McNally worked with President, Dr. Gaeta and Executive
Director, JoAnne Tarantelli to create a New York ACEP press release
in addition to national’s release. We circulated the New York
ACEP release to Capitol and statewide press and were successful in
reaching additional members of the media. Furthermore, we were able
to build on national ACEP’s strong message regarding our poor
medical liability environment, and raise awareness on New York’s
serious access problem and the State’s failure to make necessary
investments in emergency medicine. In addition to the excerpts above,
New ACEP members Sandra Schneider, MD FACEP from the University of
Rochester was quoted in the Albany Times Union while Joel Bartfield
MD FACEP from Albany Medical Center was interviewed by Albany’s
Capital News 9 discussing the findings of New York’s report card. The 2006 Legislative Session
began in Albany January 4th with Governor Pataki giving his 12th and
final State of the State Address. On January 17th, the Governor submitted
his State budget proposal. The $110.7 billion spending plan features
$4 billion in tax cuts, increases State fiscal reserves to $4 billion
and uses the projected $2 billion 2005-06 surplus to reduce out-year
gaps. Also, Governor Pataki proposed a $1 per pack state tax on cigarettes
outside of New York City, which is estimated to bring in about $308
million this year, and approximately $4 billion is expected to flow
into state coffers due to the recent Empire and other health insurance
conversions to for-profit status. As soon as the budget was
released, Assembly Democrats criticized the Governor for proposing
tax cuts that will create a $1.9 billion deficit in 2007, the year
after Pataki leaves office. They also took issue with the lack of
funding for education aid in light of the Campaign for Fiscal Equity
Court of Appeals case that directs additional aid to New York City.
Others, including Senate Majority Leader Joseph Bruno and business
leaders, hailed the proposal for its focus on business tax cuts and
economic development. Provided below is a summary
of the Governor’s budget as it relates to healthcare. Of particular
interest, the budget proposes $1.3 billion in Medicaid cuts and increases
co-payments for emergency room services to $25 for Family Health Plus
recipients. It would be helpful for members to inform New York ACEP
of the impact that this co-payment would have on you and your hospitals. Independent Office of
Medicaid Inspector General On the heels of all of this
press, Governor Pataki created an independent Office of Inspector
General by executive order. Legislative leaders as well as the leading
Democratic candidate for governor, Eliot Spitzer, immediately announced
support for the new office. Governor Pataki’s proposed state
budget puts the new office into law and greatly enhances is powers
and duties. In addition, the proposed legislation increases penalties
for Medicaid fraud and abuse. A total of $94,596,000 is appropriated
for the new office. The total amount includes a transfer of approximately
$76.2 million in existing funds, and an increase of $18.3 million
for new staff and other services. Key provisions of the bill would:
The Executive Budget
also proposes:
Pharmacy
Other Highlights
Official Prescription
Program 2006 Outlook New York ACEP’s 2006
lobby day was held Tuesday, February 28th. New York ACEP members meet
with key Senators, Assembly Members and staff, including their own
representatives to discuss ACEP’s 2006 legislative priorities.
Grassroots activities by ACEP members across the state are critical
to complement our Albany-based efforts for the advancement of the
hospital crowding legislation (A.3264, Gottfried/ S.4926, Hannon),
an increase in the Medicaid reimbursement rate for emergency medicine
comparable to primary care rates and the defeat of legislation prohibiting
balance billing of emergency services, if advanced. It is also important for members to support the New York ACEP Political Action Committee (PAC). Donations to the PAC enable ACEP members to educate elected officials and political candidates about the importance of maintaining access to high quality emergency care. Donations to the PAC are used to support political candidates in the elections process. Through these donations, members are able to attend political events and get to know their elected officials personally. New York ACEP
had a successful legislation session including: $2.5 million for a
partial restoration of Medicaid/Medicare “crossover” payments
to physicians who provide services to individuals who are dually eligible
for both Medicare and Medicaid; extension of the State’s Excess
Medical Liability Insurance Program for two more years; and a rejection
by the Legislature of the Executive’s proposed physician and
medical procedure specific taxes and fees. In addition, New York ACEP
was successful in achieving passage of legislation in the Senate and
Assembly to require that motor vehicle insurance carriers make payments
to physicians and other health care providers for the treatment of
injuries for intoxicated drivers. The passage of this legislation
follows several years of effort by New York ACEP members, Weingarten,
Reid & McNally, and a coalition of groups that included the Medical
Society of the State of New York and Mothers Against Drunk Driving. “While I
remain sympathetic to the legitimate concerns raised by health care
providers who render medical treatment to drunk drivers who do not
pay for such services, this bill does not fully resolve the issues
raised in my disapproval. Accordingly, I am constrained to disapprove
this bill. First, the magnitude
of this problem remains unclear. The only data cited are imprecise
figures extrapolated from national data. Moreover, even if the correctness
of this data is assumed, the proponents of the bill have yet to quantify
how many of these patients have health insurance or could be billed
directly for emergency services. Second, the scope
of coverage to be provided under the bill remains overbroad. Proponents
stress the need to cover emergency room treatment. I objected to the
provision in the 2001 bill that would have mandated No-Fault insurance
coverage for all services provided within 48 hours after an accident
because it would have covered non-emergency treatment and, thus, could
have been exploited by persons who engage in No-Fault auto insurance
fraud. In an effort to address the concern, this bill would mandate
coverage for a broad and undefined range of “medical screening
and necessary stabilizing treatment for emergency medical conditions.”
Although this language is intended to limit coverage to treatment
in emergency rooms, the bill language could be interpreted to mandate
reimbursement for emergency room treatment or for medical screening
and necessary stabilizing treatment for emergency medical conditions,
regardless of whether treatment would be rendered in an emergency
room setting. Thus, insurers and the Insurance Department are concerned
that this ambiguity in the bill text poses an unacceptable risk that
medical mills and fraud rings could bill for extensive and expensive
services for spurious “emergency medical conditions.” Third, in 2001
I emphasized my Administration’s commitment to compre- hensive
auto insurance reform measures to target No-Fault insurance fraud.
My 2001 disapproval stated that any bill in this area should be considered
only in the context of “broad and meaningful No-Fault reforms.”
The bill fails to include the comprehensive legislative reforms for
which my Administration has long advocated. While I am constrained
to disapprove the bill, I also recognize that current law imposes
an inequitable result on health care providers who may be unable to
collect reimbursement for treatment that, in many instances, they
are both legally and ethically obliged to provide. Therefore, I am
directing my staff to work with the sponsors and supporters of this
bill, as well as other affected stakeholders with respect to this
issue, to collect data regarding the magnitude of this problem and
to explore options for assisting doctors, hospitals and other health
care providers in dealing with the fiscal burdens created by drunk
drivers. The bill is disapproved.
(signed) GEORGE E. PATAKI While none will
disagree that the outcome is unacceptable, the success of New York
ACEP’s effort of passing this bill, given its tortuous history,
is nothing less than historic. In particular, we need to thank State
Senator Bonacic (photo left) and Assemblyman Dinowitz (below) for
their perseverance on this issue. Clearly, New York ACEP members working
together with President Dr.
Gaeta, Governmental Affairs Chairs Dr. Bosco and Dr. Sama, Executive
Director, Joanne Tarantelli and Weingarten, Reid & McNally in
Albany have demonstrated the ability to successfully advocate and
achieve results for New York ACEP members across New York State. As we look to
2006, the Legislative Session will be challenging, with numerous statewide
and local elections scheduled, a Constitutional budget amendment up
for voter approval that could significantly change the balance of
power between the Legislative and Executive branches, and a focus
in health care on Medicaid fraud. State Budget
Despite DOB’s
dire predictions, there is potential for new funding in health care
next year. The Health Care Reform Act (HCRA) fund, in jeopardy of
becoming insolvent earlier this year, received a badly needed infusion
of revenues when the State prevailed in a Court of Appeals case challenging
the constitutionality of the conversion of Empire from not-for-profit
to a for-profit status. The resolution of this case in June resulted
in the transfer of $754 million in funds that had been held in escrow.
HCRA was expected to receive another $1.1 billion in conversion proceeds
by the end of this year. However, an announcement last month that
Empire will sell the company to a large for-profit national company
is expected to nearly double that figure to $2.1 billion in cash and
another $2.1 billion in future stock sales. There is a possibility
that the State could realize an estimated $1.5 billion in additional
funds if HIP makes a similar conversion in 2006. This conversion was
under discussion last year but failed to materialize when a consensus
could not be reached on a number of issues, including how the proceeds
should be utilized. Even in the face
of new potential funding, Governor Pataki is expected to put forth
a proposed State Budget with cuts in Medicaid and other human service
programs. Elections With less than
a month to go, New York City Mayor Michael Bloomberg has spent over
$40 million on his campaign thus far, setting an all-time record for
most money spent on a non-presidential campaign. At this point in
Bloomberg’s 2001 Campaign, he had spent $29 million, which in
the end cost him $75 million in total. Currently in his 2005 campaign,
he has spent over $40 million and is expected to spend near $100 million
in the end. His opponent, Fernando Ferrer, has spent nearly $6 million,
which is less than Bloomberg’s last opponent in 2001. Governor Pataki’s
announcement that he won’t seek a fourth term creates the first
“lame duck” administration since 1982. The last lame duck
Governor, Hugh Carey, found himself largely ignored by a State Legislature
that was focused on spending money to win over constituents in an
election year. At that time, the Legislature added millions of dollars
to Governor Carey’s proposed budget in the face of huge deficits.
When Carey vetoed the spending items, the Legislature easily mustered
the two-thirds vote needed in each house to override the vetoes. Governor
Pataki’s administration could meet a similar fate in 2006. In
fact, the Democratic Assembly and Republican Senate demonstrated its
willingness to join forces and override Pataki’s budget vetoes
just two years ago in 2003. Medicaid Fraud Also mentioned
in the New York Times story is a recently completed federal Department
of Health and Human Services Medicaid audit on speech claims made
by the New York City Department of Education during an eight year
period spanning September 1, 1993 to June 30, 2001. The audit report
will go to CMS which makes the final determination on how much reimbursement
to seek. The New York Times
story drew strong reactions from politicians and candidates on both
sides of the aisle. Almost immediately, Governor Pataki appointed
a new, independent Office of Inspector General (OIG). The newly appointed
head of the office, Kimberly O’Connor, previously served as a
prosecutor in the Schenectady County District Attorney’s Office
and as General Counsel to the State Division of Criminal Services.
The Democratic candidate for Governor, Attorney General Eliot Spitzer,
voiced support for the new OIG. High ranking Republican
officials, including Senate Health Chairman Kemp Hannon, Deputy Majority
Leader Dean Skelos and Congressman John Sweeney publicly criticized
the government’s efforts and offered various solutions including
more federal audits and greater authority to county district attorneys.
On Monday, September
19th and Wednesday, September 21st, the New York State Assembly and
Senate held separate hearings on Medicaid fraud, abuse and waste.
Key testimony was given by Dennis Whalen, Executive Deputy Commissioner
for State DOH, Peter Pope, Deputy Attorney General for the Criminal
Division, and Kimberly O’Connor, the new Medicaid Inspector General.
Both Mr. Whalen and Mr. Pope defended the State’s record in preventing
and uncovering fraud and said that the New York Times story overstated
the problem. However, key legislators
in both houses seem clearly convinced that the State’s fraud
and abuse system is completely broken and in need of major changes.
While there is no clear consensus on how to address the perceived
problems, actions in 2006 could include passage of legislation to
create a state false claims act, increased and new criminal penalties
for fraud, increased funding for additional staff to investigate and
prosecute fraud and abuse, and/or increased funding for demonstration
programs to allow counties to investigate and prosecute Medicaid fraud
and abuse. In addition, it’s clear that there will be much greater
scrutiny on all Medicaid providers now and for the foreseeable future.
Both houses plan to hold more hearings before the end of the year. Constitutional
Budget Amendment
The amendment
would restore some of the budget-making power that the Legislature
lost last year when the State Court of Appeals ruled that they had
no power to amend the Governor’s proposed budget “language”
relating to items such as funding formula’s for education aid
and Medicaid reimbursement. In addition, the ruling limits the Legislature’s
budget-making authority to deleting or adding appropriations, thereby
eliminating its ability to reshape the budget by reprogramming funds
from one purpose to another. The constitutional amendment would arguably
restore the Legislature’s authority to create its own State Budget
by permitting it to independently submit an alternative budget once
the May 1st deadline is missed and a contingency budget goes into
effect. Governor Pataki
and Attorney General Spitzer are both opposed to the Constitutional
amendment. Business groups have also come out against it saying that
it would create a powerful incentive for the Legislature to delay
negotiations and virtually guarantee late budgets every year. Supporters
of the amendment, including a number of good government groups, believe
that the amendment is necessary to protect funding for vital services
and that it will force Albany to enact better and more timely budgets.
Support the
New York ACEP PAC In 2006 Weingarten, Reid & McNally will continue to work with New York ACEP in 2006 to maximize your effectiveness in Albany. A
Successful 2005 Legislative Session for New York ACEP Legislators
and the Governor were given relatively high marks by good governments
groups and the media for their efforts toward government reform. For
the first time in 20 years, the Legislature enacted an “on-time”
State Budget by the April 1st deadline. Both the Senate and the Assembly
enacted internal rule changes including a requirement for members
to be physically present in their seats for every vote, public meetings
of the previously secret Assembly Rules Committee which determines
which bills are released for a final vote on the Assembly floor, a
ban on lobbyists entering the back of the Assembly Chamber and other
changes. Government reform measures passed by both houses include
new oversight of public authorities and the New York Racing Association,
C-span like coverage of Senate and Assembly floor debates, and regulation
of “procurement” lobbying of State agency contract decisions.
The
2005 Session concluded in an orderly fashion June 24th, only one day
later than the scheduled recess. However, a number of high profile
issues were left undone including the allocation of $80 million for
nursing home wages and benefits, settlement of Indian land claims,
and expansion of Megan’s Law to protect people from sexual predators.
There is speculation that the Legislature could return to Albany later
this year to consider a limited agenda of unfinished business. In
late July, Governor Pataki announced that he will not seek a fourth
term as Governor of New York, but he committed to serving out the
remaining year and a half in his current term. Pataki’s announcement
has ignited a firestorm of speculation about both his own future and
that of the State’s Republican Party. Elected in 1994, Pataki
is the nation’s longest-tenured governor currently in office
and it is widely believed that Pataki is considering a run for national
office in 2008. At the state level, a number of names have been mentioned
as possible Republican gubernatorial candidates against Democrat and
current state Attorney General Eliot Spitzer in 2006 including Congressman
John Sweeney, Billionaire Thomas Golisano, Secretary of State Randy
Daniels and Westchester County District Attorney Jeanine Pirro. While
Pataki’s announcement was not unexpected, it is unclear how it
will affect relations between the Governor and the Legislature in
the upcoming session. Legislative
No-Fault Victory In Governor Pataki’s Hands This
year, Weingarten, Reid & McNally worked with New York ACEP and
its coalition partners to redouble efforts at passing the bill in
the Senate. It was highlighted during a New York ACEP Board lobby
day in Albany April 5th and during a coalition lobby day May 31st.
The May 31st lobby day included meetings with key staff to Governor
Pataki, Senator Majority Leader Bruno, Senate Insurance Chairman Senator
Seward, and our Senate and Assembly sponsors. Due to the grassroots
efforts of New York ACEP members, we were able to gain 10 Republican
sponsors for the bill this year. In addition, during the final week
of the legislative session, Weingarten, Reid & McNally worked
with the Senate sponsor, Senator Bonacic, to develop a press strategy
in an attempt to pass the bill. These efforts paid off as the bill
passed the Senate one day before the Legislature left for its Summer
Recess. We
then faced the task of convincing Governor Pataki of the merits of
this legislation. The Governor vetoed another version of this bill
4 years ago. Our work on this began earlier this year as we met with
the sponsors to amend the bill to address all of the issues the Governor
had raised in his previous veto message. An action alert asking members
to call the Governor to request his approval of the bill was posted
on the New York ACEP website when the legislation was transmitted
to the Governor by the Legislature. Additionally, New York ACEP and
Weingarten, Reid & McNally worked with the coalition, including
our newest partner, Mothers Against Drunk Driving (MADD) to hold an
Albany-based press conference calling upon the Governor to sign the
bill into law. New
York ACEP members should be commended for all of their efforts at
the grassroots level for the advancement of this bill. Please visit
New York ACEP’s web site at http://www.nyacep.org for an update
on the outcome of this legislation. State
Budget Victory: $5M for Medicare/Medicaid Crossover Restoration Balance
Billing Prohibition Defeated Hospital
Crowding Bill Reintroduced Although
the patient access legislation has not been advanced out of the Health
Committee of either house at this time, New York ACEP and its legislative
representatives have been very successful in educating legislators
on the gravity of this problem and the importance of taking steps
to reduce crowding and ambulance diversion at hospitals throughout
the State. Most
recently, on June 28th Dr. Samuel Bosco, Bob Reid and Shauneen McNally
met with the Director of the Office of Health Systems Management (OHSM),
David Wollner, and three members of his staff. Dr. Bosco shared the
preliminary results of New York ACEP’s most recent survey, which
shows that 90% of respondents believe that hospital crowding is still
a serious problem. New York State DOH officials acknowledged that
hospital crowding continues to be a problem across the State. Mr.
Wollner suggested the Department staff look into the possibility of
including a “mini-survey” on boarding of admitted patients
and other factors as part of the HERDS system. There was also a discussion
of possible follow-up actions that New York State DOH could take to
gain greater compliance with the New York State DOH guidelines on
hospital crowding and ambulance diversion once information is gained
from the HERDS system. Our firm requested that New York ACEP be invited
to provide input at the new Hospital Closure Commission meetings to
discuss the impact of any decisions on hospital crowding. A follow-up
meeting is planned for later this summer. Next
Steps We want to thank New York ACEP members for their strong grassroots advocacy this year and we wish you all a safe and relaxing summer. Since
the 2005 Legislative Session began in January, Weingarten, Reid &
McNally has been very busy working together with New York ACEP President
Theodore J. Gaeta, DO, Governmental Affairs Committee Co-Chairs, Samuel
F. Bosco, MD and Andrew E. Sama, MD, Executive Director, JoAnne Tarantelli
and other members of the Board and Government Affairs Committee to
advance New York ACEP’s 2005 Legislative agenda. The primary
focus of New York ACEPs 2005 legislative priorities is increased patient
access to high-quality emergency care in New York State. The Chapter’s
2005 priorities include reducing hospital crowding and ambulance diversion,
highlighting the inequitable Medicaid reimbursement rate for emergency
physicians, the advancement of No-Fault and Medical Liability Reform
legislation and defeating legislation to prohibit balance billing
of emergency services. As
this newsletter goes to print, the State Legislature has just passed
the first on-time budget in over twenty years. After months of negotiations,
and just hours before the April 1st deadline was set to expire, the
Senate and Assembly passed a spending plan totaling over $105 billion.
Included in this plan is the partial restoration of funding for Medicaid-Medicare
crossover payments for dually eligible individuals. A summary of relevant
budget issues and New York ACEP legislative priorities is provided
below. 2005
State Budget Update Partial
Medicaid- Medicare “Crossover” Payment to Physicians Secure The
legislation requires the Department of Health (DOH) to determine the
ratio of the physician’s payments to the total of the crossover
payments for services provided during this period. Weingarten, Reid
& McNally will monitor the efforts of the DOH as they implement
this legislation and determine the physician’s coinsurance enhancement
for this period. Also we will work to ensure that emergency physicians
receive their share, as determined by the DOH. Health
Care Reform Act (HCRA)/Excess Liability Prescription
Drugs Family
Health Plus |