An annual legislative hearing on the governor’s proposed state budget for health and Medicaid spending Monday focused on restructuring the state’s health system to meet the goals of government reforms aimed at cutting medical costs while improving the quality of services.
With the popular, hot-button issues of last year either resolved, under way or nixed — topics like medical marijuana, the state’s Obamacare health exchange and hydraulic fracturing — the hearing was more subdued, covering a broad range of territory and some nitty-gritty details of health policy.
A significant amount of the day’s discussion concerned the conflict between health reforms that seek to cut costly hospital stays and the desire to keep hospitals operating in their communities as they transform the way they provide care.
Topics included plans to distribute $6.4 billion in Medicaid waiver funds from the federal government — funding that had not been secured a year ago — under a competitive application system that calls for collaboration among hospitals and health systems. The state also plans to award $400 million to rural hospitals and $700 million to hospitals in Brooklyn and Oneida County. The Oneida County funding was awarded after the region submitted what state Medicaid Director Jason Helgerson called a “unique proposal” to the state.
Senate FInance Committee Chairman John DeFrancisco asked Helgerson if other regions knew they could receive money if they could apply for money.
“No, they did not,” Helgerson said.
“That doesn’t seem fair,” DeFrancisco said.
Of concern to some lawmakers was a proposed cut in Medicaid reimbursements to pay pharmacies for prescription drugs according to a formula that calculates the average wholesale price of the drug and then subtracts 24 percent. The formula was derived following a survey of pharmacies, state Medicaid Director Jason Helgerson said.
“I don’t think in this market that’s attainable, unless we get to purchase drugs from Canada,” said Assemblyman John McDonald, who owns Marra’s Pharmacy in Cohoes.
Lawmakers pressed Executive Deputy Commissioner of Health Sally Dreslin on a March 27 deadline for having all-electronic systems in place for prescribing medicine, including narcotic painkillers and other controlled substances. Doctors, hospitals and other medical providers have requested an extension on the mandate, stating that its implementation is costly and in the hands of private software vendors as well as the federal Drug Enforcement Administration.
Dreslin said she was hopeful that an agreement could be reached that would meet the needs of providers as well as the state’s goals to reduce prescription errors and improve patient safety. Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, pointedly asked why providers haven’t already been told if an extension is likely.
“If it’s going to be postponed, it would certainly be at least polite to let people know that sometimes before March 27,” Gottfried said.
Helgerson was questioned about the Cuomo administration’s plans to implement a Basic Health Plan under the federal Affordable Care Act. It would provide free medical services to New Yorkers who earn too much money to qualify for Medicaid, but remain below 200 percent of the federal poverty level. The federal government would kick in $600 million to get the program started. But Senate Health Committee Chairman Kemp Hannon said he was concerned about supporting the program afterward.
“I wonder what happens the second, third and fourth year,” Hannon said.
Several lawmakers expressed concern over the administration’s proposal to save $1.2 million by eliminating the Physician Profile Website, which allows consumers to look up information about their doctors. Dreslin said the information on the site was available to consumers elsewhere, but lawmakers including Hannon and Sen. Liz Krueger praised the easy access of the state site as well as the Health Department’s ability to monitor it.
Senate Health Committee Chairman Kemp Hannon chastised Dreslin for the Health Department’s inaction in two areas: a lack of report from a Lyme disease task force established last year, and delays in restructuring its organ transplant process.
