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Governor Cuomo Releases $168 Billion Budget Proposal - Excess Liability Program Continued Unfettered, but Several Scope of Practice Expansion Provisions Proposed

Governor Cuomo has released his proposed $168.2 Billion Budget for the 2018-19 Fiscal Year.  The Budget proposal seeks to close a $4.4 billion Budget gap, including through  $1 billion in “revenue raisers”.

Based upon an initial staff review of the thousands of page of Budget language and supporting documents, among the proposals of interest/concern to physicians include:

Some positive items include:

  • Extending the Excess Medical Malpractice Insurance Program for another year at the historical level of $127,400,000, without conditions proposed in previous Budgets
  • Continue CPH funding at historical funding level of $990,000
  • Re-appropriation of $150,000 for MSSNY’s Veterans’ Mental Health Initiative
  • Reducing interest rate on all court judgments, both against public and private defendants, from 9% to market rate (which is currently less than 2%)

Some items of significant concern include:

  • Permit independent practice for Nurse-Anesthetists
  • Permit corporate-owned retail clinics, provided they have a collaboration with hospital, physician, ACO or PPS
  • Permit collaborative drug therapy arrangements between pharmacists and nurse practitioners (current law only permits it between pharmacists and physicians)
  • Require prescribers to have a detailed opioid treatment plan for their Medicaid patients who have been on an opioid for more than 3 months or past the time or normal tissue healing.

Items of Interest and Further Review

  • Establish a “Healthcare shortfall fund” to pay for continued health insurance coverage (Essential Plan, CHIP, etc.) to be funded by health insurer conversion dollars (such as the Centene purchase of Fidelis).
  • Establish a 10 cent per milliliter tax on vapor products
  • Establish an opioid surcharge on pharmaceutical manufacturers of 2 cents per milligram of active opioid ingredient on prescription drugs
  • 14% surcharge on health insurers for underwriting gains from health insurance policies
  • Medicaid coverage for telehealth services initiated in a patient’s home
  • Board for Medicine would include physician experts in women’s health and disparities
  • Conduct a study regarding the potential legalization of marijuana in New York
  • Prohibiting the suspension of professional licenses for those who fall behind in student loan payments;
  • Grant powers to the State Budget director to create a “Medicaid Savings Allocation Plan” to establish cuts to health programs to account for shortfalls in federal funding

Of further note, the Budget proposal did not contain provision from previous years’ Budget proposals that MSSNY opposed, such as removing the ability of county medical societies to review applications of physicians to participate in Workers Compensation, and required accreditation of urgent care practices.

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