On March 12, the NYS Assembly and Senate passed their own differing "one-house" budget bills for State fiscal year 2008–09, which begins April 1. Both the Senate and Assembly rejected many of the cuts proposed by the Executive; however, given the deteriorating state of the economy, neither house rejected all of them. GNYHA is grateful to Senate Majority Leader Joseph Bruno and his conference and Assembly Speaker Sheldon Silver and his conference for addressing many of the concerns that are important to GNYHA members. The Senate and Assembly will now proceed to convene conference committees to iron out the differences between the one-house bills. GNYHA will continue to work with the Legislature and the Administration on these proposals to protect GNYHA members from cuts.

Hospitals: Neither the Senate nor the Assembly budgets would allow Medicaid inpatient rebasing or Medicaid outpatient reimbursement reform to begin on July 1, 2008, as under the Executive's proposal. The Assembly would postpone implementation until Jan. 1, 2009, require consultation with the health care industry and a technical advisory committee on data and methodologies, and require Federal approval for both inpatient rebasing and outpatient reforms before either could become effective. Unlike the Assembly, the Senate would require further legislative approval before inpatient rebasing or outpatient reforms could be implemented. 
     
Importantly, neither the Assembly nor the Senate accepted the Executive's proposal to phase out workforce recruitment and retention funding. Both the Senate and Assembly accepted the proposal to shift $15.6 million from the private payer graduate medical education (GME) pool to fund the new "Doctors Across New York" program in 2008, but both houses rejected the proposed deeper cuts to the GME pool in 2009. 
     
The Assembly accepted the Executive's proposed changes for bad debt and charity care, which would be phased in beginning Jan. 1, 2009, while the Senate would allow data collection to begin but would not allow a new bad debt and charity care funding distribution methodology to be implemented.

Behavioral Health: The Assembly would postpone the Executive's inpatient detoxification reimbursement cut and reforms until Jan. 1, 2009, and phase them in over four years; the Senate accepted the Executive detox proposal without amendment. Both the Senate and Assembly rejected the proposed cut in specialty mental health rates, which would harm 10 hospitals across the State.

All Providers: The Assembly accepted the proposed 35% cut in the Medicaid trend factor, while the Senate reduced the trend factor cuts to 17.5%.

Nursing Homes: The Assembly accepted all the Executive budget proposals. The Senate rejected the proposal to eliminate nursing home rebasing funds for years prior to 2008, and proposed to postpone the scheduled Medicaid-only case-mix cut from 2009 to 2010.

Home Health Care: The Senate eliminated the proposed caps while the Assembly mitigated the cuts by 1) reducing the rate ceiling cap for certified home health agencies from 110% to 105% (compared with the Executive proposal of 100%), and 2) redefining the administrative and general (A&G) definition to exclude certain costs that are currently included under the cap, before reducing the cap, as the former Governor had proposed, to 20%.

Medical Malpractice Reform: The Senate has included a place-holder to address medical malpractice reform.