healthsignals new york

The Medicaid political challenge

Well nothing may come of this but, county officials who have threatened to challenge New York's political order in response to the continued financial burden of Medicaid, are actually now running candidates against incumbents. They had threatened before. Now they're doing it. There's one from each party and both are challenging a majority from Long Island.

According to the New York Times, Joshua Ketover is a Long Island lawyer specializing in personal-injury work is challenging Dean Skelos, Republican of Rockville Centre, the Senate's deputy majority leader. Charles D. Lavine, a Glen Cove councilman, will be running against David Sidikman, a Democrat in the Assembly.

Both of the challengers have the endorsement of Tom Suozzi, who has been pushing on this issue and threatening this challenge for months.

(As of this writing the permanent link for the Times story is not available.)

So how does this capital bill differ from the draft?

Well at first glance, two types of providers are explicitly included that were not part of the original draft, community health centers and home health care. But note that community health centers get their own section.

Here's the text and here's the statement of legislative intent regarding community health centers.

Home care is buried in with the hospitals in this section in this language:

(b) "Facility". A facility shall mean an existing or proposed healthcare facility or information technology system for a health care facility, and other appurtenances thereto to be utilized for information technology, a provider of home care services as defined in section three thousand six hundred two of this chapter, or other purposes incidental to projects for the improvement of health care delivery within the state.

Now the $25 million that the community health centers get isn't much compared to the $975 million that's left, but at least it's reserved for them. The home care folks will have to fight it out with the hospitals and nursing homes. Prediction? It won't even be close.

We'll parse this out much more closely over the next couple of days.

Capital bill Section 6

§ 6. This act shall take effect immediately.

Capital bill Section 5

The text of new law is underlined ...

§ 5. The public health law is amended by adding a new section 17 to read as follows:

§17. Community health centers capital program.

Capital bill Section 4

§ 4. Statement of legislative findings. It is hereby found and declared that freestanding not-for-profit community health centers provide critically needed primary and preventive care to low-income communities throughout the state.

Capital bill Section 3

The text of new law is underlined ...

§ 3. The public authorities law is amended by adding a new section 1680-j to read as follows:

§ 1680-j. Authorization for the issuance of bonds.

Capital bill Section 2

The text of new law is underlined ...

§ 2. The public health law is amended by adding a new section 18 to read as follows:

§ 18. Health care system improvement capital grant program.

Capital bill Section 1

Section 1. Statement of legislative findings and purposes. It is hereby found and declared that restructuring of the state's health care delivery system must be accomplished in a planned, orderly manner that considers access, workforce, and indebtedness issues and in a way that can result in maintaining high quality health care services while significantly reducing health care costs.

It is further found and declared that the future of our health care system depends upon a well-trained workforce that is prepared for the revolutionary changes in health care delivery that will take place in the coming years.

It is further found and declared that the long-term improvement of the health care delivery system may depend, in some instances, upon restructuring of health care facilities, including appropriate closure, consolidation, or conversion.

It is further found and declared that the public health of the citizens of the state will depend upon the implementation of information technology systems by health care providers that will improve access to care, improve the management of health care and chronic diseases, enhance patient safety, reduce medical errors, and enhance the efficiency of accounting and payment practices of health care institutions; and that significant financial barriers to obtaining such systems exist, which can be overcome through a system of state financial support.

It is further found and declared that investment by the state in these initiatives will produce long term economic benefits to the residents of the state, and that state financial support of the capital costs of restructuring and of health care information technology will improve the quality and efficiency of the health care delivery system, benefit the public health, reduce economic stress being experienced by health care facilities and their employees and reduce costs to the system.

For these purposes, there shall be created a statewide program which, through State financial support, enables health care providers to obtain the capital resources necessarily related to the restructuring of health facilities and to obtain information technology systems needed to provide more efficient and economic health care.

Capital bill header & title

STATE OF NEW YORK

A. 11705

IN ASSEMBLY, June 19, 2004

Introduced by COMMITTEE ON RULES -(at request of M. of A. Silver, Gottfried, Farrell, Tokasz) -read once and referred to the Committee on Health

AN ACT to amend the public health law, in relation to establishing a statewide capital grant program to improve the quality and efficiency of the health care delivery system through appropriate closure, conversion and restructuring of health care facilities and through the implementation of information technology systems to provide improved, cost effective patient care; and to amend the public authorities law, in relation to the authorization for the issuance of bonds; and to amend the public health law, in relation to establishing a statewide capital program for not-for-profit community health centers

The People of the State of New York, represented in Senate and Assembly, do enact as follows:

Blog & legislative analysis experiment

We've talked extensively about the draft legislation that would have one of New York's public authorities borrow a $billion and then give it away, primarily to hospitals. Take a look here, here, here, here, here, here, here, and here.

The original draft was developed by the Greater New York Hospital Association and walked around by it and its partner union, District 1199/SEIU. HANYS, the NYS Healthcare Association, which represents hospitals throughout the State supports such a proposal itself.

The hospital folks got feedback when they walked the draft around. And, of course, others got wind of it and wanted their share too. So the bill was re-drafted. Many expected emergence of a new draft and its introduction to be a sign that Legislative quitting time was nearing. (Please don't beat us up for our liberal use of "quitting time." As everyone in Albany knows, they are going into recess with relatively little done - including the budget.)

As so now we have a new draft. Except this one's been introduced formally (A. 11705) by the Committee on Rules with the Speaker as the primary sponsor in the Assembly. Bills introduced with the Speaker's name first are a big deal so this one is rocketing through the Assembly. As of yesterday afternoon, the bill had already been reported by the Committees on Health and Ways & Means and was on the floor.

When I analyzed the first draft, several folks asked why I had interpreted it in the manner I did. Others asked for a copy. So here's what we're going to do.

I'm going to post the bill itself online section by section. Then when I analyze each section, I'll link back to the actual text. Using the comment function, you can offer your own interpretation or other comment.

This is pure wonkery. But remember that all this has consequences. In this case, it looks like we're on track to give away a billion bucks. I don't expect my analysis or your comment will have any effect on this bill. But at least those folks who care about these sorts of issues will be able to read more than a headline.