The 2022 legislative session recently concluded, so we wanted to send an update on specific issues of importance.  While the session began remote and concluded in person, the final numbers show that it was one of the busiest legislative sessions in decades.  The pace at which legislation passed was on a level not seen since 1995, which was over 25 years ago. All told, the Assembly and Senate passed 1,007 bills.  This compares to 892 bills passed in 2021, which was record breaking at the time. The majority of the bills that passed both houses are still awaiting review and signature by the Governor.

For the Association, we are tracking nearly 250 active bills that would impact NYSCA members.  In 2022 alone, 32 new bills were introduced that we are now tracking.  These standalone bills are separate and apart from the legislation and initiatives that were also included in the State budget, which passed in early April.  Please find below a summary of the main issues of note.

Budget Initiatives

• Telehealth Payment Parity: There was a provision included in the final budget that will require payment parity for telehealth services. The language also added mental health practitioners to the list of authorized providers. We had discussed adding chiropractic to the list of providers in the budget as well. At the time, we were told that chiropractors were not included because they were covered elsewhere.  We have since learned that the issue has to do with Medicaid coverage, and it is an issue we will research and discuss further.

• Surprise Medical Bills: The 2020 Federal No Surprises Act (NSA) was included in the Federal Consolidated Appropriations Act of 2021.  The NSA provides federal consumer protections against surprise billing, limits out of network cost sharing under many of the circumstances in which surprise bills arise most frequently (e.g., balance billing, provider directory inaccuracies), and establishes continuity of care and health plan ID card requirements.  Most provisions are effective for plan years beginning on or after January 1, 2022.  While some NSA requirements are similar to existing New York requirements, there are some that are either not addressed, or are more expansive than, existing New York law, regulations, policies, and procedures.  The budget provision aligns New York consumer protections with the NSA.

• Coverage for All:  The final budget expands Medicaid coverage, regardless of immigration status, to (1) individuals during their first-year of post-pregnancy and (2) undocumented immigrants over the age of 65.  In addition, the budget expanded eligibility for New York’s basic health program and increases the federal poverty limit cap for basic health program eligibility from 200% to 250%.  This proposal was intended as a compromise, as progressives in both the Assembly and Senate were pushing to include Medicaid for All in the budget.

• Transfer Oversight of Medical Professions from the State Education Department of the Professions to the Department of Health:  The Governor’s proposed budget included a provision that would transfer oversight of all medical professions to the Department of Health.  While our preference was for oversight to remain with the State Education Department, which is what ultimately happened, our arguments were really focused on the issue that regardless of which agency was doing the oversight, they must get the appropriate funding and resources to hire enough employees to meet the workload demand of the Office of the Professions.

Bills Passed Both Houses

• Opioid Alternative - S4640/A273:  Getting this bill passed was one of our top priorities for this session.  This bill, once signed by the Governor, requires practitioners treating patients with a neuromusculoskeletal condition that causes pain to consider, discuss, and, if appropriate, refer or prescribe non-opioid treatments before prescribing an opioid.  The requirement would not apply during a medical emergency, immediate post-surgical care, hospice or end-of-life-care, or cancer treatments.  Non-opioid treatments include, among other things, chiropractic care.  Once signed by the Governor, the bill will take effect immediately and would result in chiropractic being listed in statute as a viable alternative to an opioid prescription.

• Billing of Facility Fees - S2521-C/A3470-C: This bill requires notices to be issued to patients prior to hospitals or professional practices charging facility fees.  This notice must include whether the patient’s health insurance will cover the fees. The bill does not prohibit providers from charging facility fees to patient, but the notice must be given prior to the patient receiving medical care.  The bill will become effective 180 days after it is signed by the Governor.

• Hospital Equity and Affordability Legislation (HEAL Act) – S7199-A/A8169-A: This bill prohibits insurance companies from entering into contracts with certain anti- competitive clauses, including the most-favored-nation provisions. The bill is intended to go after the impact of hospital consolidations on patient prices.  Further, the bill would also allow insurers to disclose price and quality information regarding the negotiated rates with health care providers. We have been watching this issue very carefully to see what impact it may have on payment information. If signed by the Governor, the bill will take effect on January 1, 2023.

The bills that have passed both houses have yet to be sent to the Governor.  We will be monitoring these bills carefully and will weigh in appropriately when the bills are sent to the Governor for her review.

Bills That Did Not Pass Both Houses

• Telehealth Payment Parity - S7130/A7369-A, A9467-A: As mentioned in the budget update above, chiropractors were excluded from the telehealth bill in the budget because we were told that they were already covered under a different provision of law.  Only after the budget passed did the real issue emerge:  Medicaid does not currently cover chiropractic treatments.  Although the bill did pass in the Senate, we were not able to get it passed in the Assembly because of the Medicaid issue. As noted above, this is an issue that we will be continuing to review and will discuss next steps.

• Modernizing the Scope of Chiropractic Care - S1319/A4358:  This bill remains our number one legislative priority and would update and modernize the chiropractic scope of practice.  This legislation recognizes the changes in the education and training of chiropractors, while ensuring that the profession remains surgery and drug free. In the 50 plus years since the licensed profession of chiropractic was recognized in New York, there have been significant advances in the educational standards and training for doctors of chiropractic. As such, this legislation would update and modernize the scope of practice to reflect the evolution of the practice of chiropractic and the significant changes and developments that have happened in the educational curriculum since 1963.  We had numerous conversations regarding advancing this legislation, and we will be working in the off session with the Senate to convene a roundtable with other interested providers to attempt to understand where their opposition might lay.

• Professional Service Partnerships for Health Services Professionals - S6872/A3526:  This bill would allow numerous healthcare professions to form PLLCs and other types of professional partnerships.  The professions impacted would include chiropractors, physicians, pharmacists, massage therapists, and occupational therapists. The bill would also allow for multidisciplinary service practice partnerships.  Further, the bill would clarify that multidisciplinary service practice partnerships would be distinct from hospitals.  The bill did not advance in either the Assembly or Senate.

• Limited Permit - S6645:  This bill was a priority during the pandemic because the national licensing test was not being offered, so chiropractic students had no way of practicing in New York.  The solution to this issue was to create a limited permit for chiropractic care.  A limited permit would allow a graduate of a chiropractic school to practice in New York, under the supervision of a licensed individual in order to protect public health and safety, until such time as the graduate can complete all of the requisite testing required to receive their national certification, which would then allow them to be licensed in New York. This change will classify chiropractic graduates in the same manner as all other professions’ graduates. This provision is also included in the scope modernization bill.  As the testing issue has been resolved for now, we are focusing on the broader scope bill to resolve this issue but will pursue this bill as a standalone piece if the issue arises again.