Mental Health Update

NEW YORK CITY – (12/19/2023, 10:00 a.m., Hunter College, 904 Lexington Avenue)

The Assembly Standing Committees on Health, Mental Health, People with Disabilities, Higher Education, and Labor held a public hearing Tuesday morning to examine the status of New York State’s health care workforce. Health Chair Amy Paulin, Mental Health Chair Aileen Gunther, Disabilities Chair Rebecca Seawright, Higher Education Chair Patricia Fahy, and Labor Chair Latoya Joyner, and Assembly Members Jo Anne Simon, Jonathan Jacobson, Christopher Eachus, Christopher Burdick, Harry Bronson, Jessica Gonzalez- Rojas, Josh Jensen, Jodi Giglio, Matthew Slater, and Michael Durso were in attendance.

A Persistent Staffing Crisis

“Healthcare organizations across the state continue to face great workforce and physical challenges,” said Bea Grause, President of the Healthcare Association of New York State, noting this comes at a time where a demand for care is only increasing. “We do not have the workforce necessary to meet today’s or tomorrow’s demands,” she stressed. “This is only going to get worse,” cautioned Diane Darbyshire, Vice President of Advocacy and Public Policy at LeadingAge New York.

Gary Fitzgerald, President and CEO of Iroquois Healthcare Alliance, said 20 percent of all registered nurse (RN) positions are, at present, vacant. Overall, said Fitzgerald, 16 percent of all health care staffing positions are currently unfilled. He would also challenge the notion that staffing issues can be remedied by higher salaries alone; “It’s more than that,” he insisted. During questioning, Tim Johnson, Senior Vice President of the Greater New York Hospital Association, would agree that higher salaries are insufficient on their own to ensure a stable workforce.

Marie Mongeon, Vice President of Policy at the Community Health Care Association of New York State, said despite their best efforts at offering enticing salaries, health centers are simply unable to match pay offerings from traveling nursing agencies, for-profit providers, or otherwise large care entities.

Matthew D’Amico, Political Action Coordinator for the Civil Service Employees Association (CSEA) and Frederick Kowal, President of the United University Professions (UUP), brought attention to the issue of the public employee pension system, calling lower tiers such as Tier 5 and especially Tier 6 detrimental to the recruitment and maintenance of the State’s healthcare workforce. Kowal would also raise alarms over the State’s “acute shortage of specialists,” compounding even further the issue of a general workforce shortage.

Pat Kane, an RN and the Executive Director of the New York State Nurses Association (NYSNA), classified the staffing level of member nurses as “unsafe,” while also noting persistent abuse of nurses in the workplace has pushed otherwise highly qualified and capable professionals out of the healthcare sector entirely.

Winifred Schiff, CEO of the InterAgency Council of Developmental Disabilities Agencies Inc., said she entered the healthcare field when wages amounted to twice that of minimum wage but expressed doubt over whether or not she would have stayed in the field if compensation was at its current level, which she and other speakers equated to that of lower- skilled fast food wages.

Edward Mathes, a Physician Assistant (PA-C) and President of the New York State Society of Physicians Assistants (NYSSPA) said an informal survey showed 30 percent of PA-C course graduates leave New York State after certification, the majority citing difficulty finding a position due to supervision requirements.

Dr. Paul Pipia, President-Elect of the Medical Society of the State of New York (MSSNY), spoke on the impacts of burnout on the healthcare workforce, particularly during and in the aftermath of the COVID-19 Pandemic. Exasperated by staffing shortages, persistent burnout serves as an impediment to workforce retention.

Chair Gunther, identifying herself as an RN, railed against the salaries of hospital executives – CEOs and CFOs – particularly in non-profit institutions. “I worked in a hospital for years and years,” she said, “and I never saw them at midnight on a snowy night.”

Eachus expressed support for reforming Tier 6 retirement, noting the State has, in the past, folded lower tiers into higher strata.

Interstate Licensure Compacts

Much of the day’s discussion revolved around the question of whether or not New York State should join either, or both, the Interstate Medical Licensure Compact and Interstate Nurse Licensure Compact. Entry into these compacts have been introduced by Governor Hochul during the last two Budget cycles but in both instances were left out of the final Budget. Encouraging people to view the pacts as separate issues, Johnson explained how the two compacts differed: the Medical Compact allows merely for a sharing of information to facilitate a licensing of professionals moving from state to state while maintaining the exclusive right of individual states to license physicians within its jurisdiction; the Nurses Compact, in contrast, removes licensing power from the constituent states and places it with the Compact authority itself.

Grause called for New York State to enter into both the Nurses and Medical compacts in order to facilitate the entry of individuals into the State’s healthcare workforce. Fitzgerald called for joining these interstate compacts – which he noted over 40 fellow states had already entered – saying it would be the “minimum” the state could do. Johnson and Mongeon called for the state to join both compacts, as did Stephen Hanse, the President and CEO of the New York State Health Facilities Association.

Amy Lee Pacholk, an RN and member of the Public Employees Federation (PEF), said her organization opposes State entry into the Interstate Compacts, citing concerns over insufficient abortion care training for a nurse hailing from a state where the procedure is severely restricted. She further stated that nursing shortages are endemic across the country and the pacts would have the effect of moving health care professionals from one area of severe need to another.

Dr. Pipia said MSSNY was concerned over out-of-state doctors coming into New York State to compete for clients against New York physicians but encouraged allowing out-of-state doctors with preexisting relationships with patients in the State to continue those relationships.

When asked by Chair Paulin for their position on the Interstate Compacts, representatives from both the 1199 Service Employees International Union ( SEIU) and the Communications Workers of America (CWA) Union responded that neither organization currently has a stance on the matter.

Other Potential Policy Solutions

Speakers persistently called attention to New York’s Medicaid gap, the difference between the cost of care and the financial assistance provided by both the State and the federal government to pay for that care. While rates had been augmented by the Legislature in the last year, speakers were unequivocal in saying current offerings are insufficient to meet current needs. Mongeon cited a study from the Urban Institute which showed health center costs to be, on average, 44 percent higher than the maximum health center Medicaid rate.

Grause highlighted a few recommendations for improving the current outlook of the healthcare workforce. Among them, she called for allowing certified medication technicians to administer, under supervision, certain medications in nursing homes. Grause further called for the Legislature to formally recognize certified nurse anesthetists under State law. To help ease financial stress on healthcare institutions, she also urged the State to relax some of its regulatory and administrative standards, including a repeal of the COVID-19 era sick leave statute. Grause also suggested the establishment of a dedicated capital program, as well as altering elements of the penal code, to help protect care workers from violence in the workplace.

Fitzgerald endorsed the passage of the original version of a bill (currently a B print) which would temporarily authorize certain nursing applicants for licensure (A.6697, the original version having no Senate companion). He also endorsed legislation establishing the Take A Look pilot program for dental workforce recruitment (A.8368).

Sarah Ravenhall, Executive Director of the New York State Association of County Health Officials urged Governor Hochul to sign two pieces of legislation currently awaiting action on her desk: one bill providing reimbursement for certain home health services (A.7365 / S. 6641); another bill alleviating certain regulations on local health department-run clinical services (A.2400 / S.6219). Further, Ravenhall endorsed proposed legislation to expand eligibility for county board of health positions (A. 8232).

Mongeon endorsed proposed legislation to reform health center rates (A.7560 / S.6959), expand the pay parity of telehealth services (A.7316 / S.6733), and permit licensing of dental therapists (A.5373 / S.4428).

Pacholk urged the Legislature to invest in loan forgiveness programs for health care professionals as a means for incentivizing new entry into the field. “PEF believes these workers should be given immediate loan relief in exchange for meeting their work requirements,” Pacholk said. While she classified the State University of New York (SUNY) as a potential “game changer” in combating workforce shortages, Pacholk said the system is underutilized in this capacity and urged a greater focus on using universities as a steppingstone for health care professions.

Glenn Liebman, CEO of the Mental Health Association of New York State ( MHANYS), urged a new round cost of living adjustments (COLA), this time at 3.2 percent (consistent with the consumer price index), for mental and behavioral health workers. Further, MHANYS will be seeking a $500 million State investment specifically earmarked for mental health services. Luke Sikinyi, Director of Public Policy and Engagement at the New York Alliance for Rights and Recovery, reiterated Liebman’s requests, saying years of underinvestment have left mental health care at a severe shortfall which recent intervention has not been nearly sufficient to redress.

Mathes endorsed proposed legislation amending State standards pertaining to PAs and eliminate certain related administrative barriers (A.8378).

Dr. Pipia endorsed proposed legislation to prohibit repeated prior authorization requirements once services are initially authorized by a health insurer (A.7268 /S.3400).

Chair Fahy expressed support for MHANYS’ request for a new round of COLA.

Laura Ehrich, Vice President of Public Policy for the New York State Association of Health Care Providers (HCP), urged passage of the Fair Pay Accountability Act (A.7335 / S.6963) which would establish regional reimbursement rates for home care workers, as well as proposed legislation providing payments for home and community based long-term care services (A. 7473 / S.5473).

Jeanne M. Chirico, President and CEO of the Hospice and Palliative Care Association of New York State (NHPCO), called for augmenting curriculum requirements for nurses, physicians, and social workers by adding an understanding of the minimum standards of palliative care to graduation prerequisites. In addition, similar palliative care instruction should be provided to all current healthcare and social work professionals, according to Chirico.