State of the State: Cuomo announces plans to combat violence, expand access to telehealth

Over the weekend, Gov. Andrew Cuomo continued to reveal details of his State of the State.

Combatting Violence

He announced a comprehensive package of initiatives to combat domestic violence and gender-based violence. The package includes a proposal allowing courts to require abusers to pay for damages to the housing unit, moving expenses, and other housing costs related to domestic violence, as well as a proposal to require the Office of Court Administration report domestic violence felony statistics to the New York State Division of Criminal Justice Services monthly.

Additionally, the Office for the Prevention of Domestic Violence will be transformed into a reimagined agency, the Office to End Domestic and Gender-Based Violence, and will be tasked with addressing the intersection of the many forms of intimate partner violence, including domestic violence and sexual violence, in a survivor-centered and comprehensive manner.

"One of the most horrific results of this pandemic has been the stark rise in cases of domestic and gender-based violence," Cuomo said. "New York has long been a national leader in the fight to end these despicable acts and we will continue to blaze the path forward toward a safer future for all. Not only are we fighting to ensure abusers are forced to pay for the damage they create and strengthening our laws to keep guns out of their hands, but we are also reimagining the way government supports survivors and gets them the resources they need to move on with their lives."

Secretary to the Governor Melissa DeRosa, and chair of the New York State Council on Women and Girls, said, "Under the leadership of Gov. Cuomo, New York has long led the nation's fight against domestic violence and, with the tragic increase in this heinous acts spurred on by the pandemic, we are doubling-down on those efforts. This disgusting behavior must end and, to do that, we are fighting to ensure abusers can no longer exploit loopholes to obtain guns and are the ones forced pay for the results of their devastation. However, it doesn't end there: We need to reimagine how government supports survivors and gets them the resources they need. Through the new Office to End Domestic and Gender-Based Violence, New York will embark on a holistic, survivor-focused approach towards helping rebuild lives."

A press release stated, “While New York has made remarkable progress on housing rights, the state must continue to maintain its strong commitment by taking bolder steps forward. In line with that goal, Gov. Cuomo is proposing to allow courts to require abusers to pay for damages to the housing unit, moving expenses and other housing costs related to domestic violence.”

Currently, in order to disqualify individuals found guilty of serious misdemeanors from obtaining a New York gun license, they must be found to have committed the crime against someone with whom they were in a domestic relationship after a separate hearing.

The press release explained, “Many disqualifying domestic violence misdemeanors are not ‘labeled’ as such because the process to label state-disqualifying DV misdemeanors is cumbersome. While New York took a step toward closing this loophole in 2020 by ensuring that court clerks report these disqualifying convictions in a timely manner, some convicted of serious misdemeanors may still be able to purchase a gun if this multistep process is not followed. As a result, some convicted of serious misdemeanors have still been allowed to purchase a gun.”

Cuomo proposes the creation of a domestic violence misdemeanor label to “close the domestic violence gun-purchasing loophole.” In addition, the governor will propose legislation to require the Office of Court Administration report domestic violence felony statistics to the New York State Division of Criminal Justice Services monthly to ensure domestic violence incidents are able to be counted.

The press release noted, “By creating the Office to End Domestic and Gender-Based Violence, Gov. Cuomo is building a permanent and unified hub of policy and state-of-the-art programming for New Yorkers facing gender-based violence, bringing together multiple efforts to address gender-based violence throughout state government. The office will encourage collaboration among agencies and service providers, eliminate redundant processes, cut red tape, and permanently install the fight for gender equality and justice for survivors as a pillar of New York state government.

“The tenacity of New York women and the governor's commitment to gender equity has kept the issues of domestic violence and sexual assault prevention at the top of New York state's agenda. Throughout his time as governor, Gov. Cuomo has signed extensive legislation relating to ensuring safety for girls, women, and all survivors of domestic trauma and abuse, including legislation in the FY2021 budget authorizing law enforcement to remove guns from the scene of a domestic violence incident, and requiring judges to consider the effects of domestic violence while determining distribution of marital property. Acknowledging that college students have the right to a safe, healthy and nurturing environment free from discrimination and violence, Gov. Cuomo signed the ‘Enough is Enough’ law in July 2015 to address sexual assault, dating violence, domestic violence and stalking on college campuses.”

Following a spike in domestic violence during the COVID-19 pandemic, DeRosa and the New York State Council on Women and Girls announced in May the creation of a new task force to find innovative solutions to this crisis. Through the governor's Council on Women and Girls, the 2019 Domestic Violence Task Force, and the 2020 COVID-19 Domestic Violence Task Force, Cuomo's administration has collected recommendations from providers, survivors, family members and administrators, and begun to implement a comprehensive flexible-funding model to support a continuum of services based on each survivor's needs. The model also supports survivors by enhancing systemic responses that hold abusers accountable and decrease their levels of lethality.

Among the programs already underway are a new 24/7 text and chatline for those experiencing domestic and sexual violence, a housing navigator pilot to enhance housing options for survivors, the creation of a statewide data collection system, new training and resources for those working with incarcerated populations and immigrants, a listening tour to speak directly with survivors regarding their needs, and enhanced communication regarding shelter availability.

Proposal to Expand Access to Telehealth for All

Cuomo announced legislation to expand and improve access to telehealth for all as part of the 2021 State of the State. His team said, “The COVID-19 pandemic laid bare the inequities in our health care system and showed that telehealth is a critical tool to expand access and lower costs for low-income communities, especially for behavioral health support. During the crisis, the governor took executive action to expand access to remote care, and these proposals codify and build on those successful reforms.

“In partnership with the Reimagine New York Commission, the governor will enact comprehensive telehealth reform to help New Yorkers take advantage of telehealth tools and address existing roadblocks. These reforms will address key issues like adjusting reimbursement incentives to encourage telehealth, eliminating outdated regulatory prohibitions on the delivery of telehealth, removing outdated location requirements, addressing technical unease among both patients and providers through training programs, and establishing other programs to incentivize innovative uses of telehealth.”

Cuomo said, "While New York state has been on the cutting edge of promoting telehealth for its residents, the adoption of telehealth by both patients and providers has been slow. COVID-19 has changed not only the way we live, but the way health care providers support their patients, especially in regard to mental health. New Yorkers have adapted throughout 2020, but it is time to push telehealth to the next level in New York state and fully integrate it into our existing health care system. These proposals will better allocate our health care and technological resources for the 21st century."

The governor proposes comprehensive reforms to permanently adopt COVID-19-era innovations that expanded access to physical health, mental health and substance use disorder services including:

•Unlocking the Benefits of Telehealth Through Policy Modernization – Cuomo’s proposal includes the following regulatory and statutory changes to allow for greater flexibility in where and when patients use telehealth, while maintaining oversight to ensure high-quality care is delivered:

√ Eliminating obsolete location requirements by requiring Medicaid to offer telehealth reimbursement for services rendered to patients regardless of where the patient or provider is located in a non-facility setting;

√ Developing interstate licensing reciprocity with states in the Northeast region for specialties with historical access shortages to ensure there is sufficient access to medical and behavioral health professionals; and

√ Continuing COVID-19-era flexibilities for mental health and substance use disorder services by allowing certain unlicensed staff, such as credentialed alcoholism and substance abuse counselor trainees or peer specialists, to deliver substance use disorder and mental health services. This also includes eliminating the remaining in-person evaluation requirements before telehealth services can be delivered, expanding the types of staff who can deliver remote services, developing a regulatory structure for a predominantly virtual outpatient substance use disorder treatment program, and exploring the expansion of existing initiatives that extend behavioral health services into nursing facilities. This will include reimbursement of all mental health and substance abuse provider types, including certified recovery peer advocates so patients and providers can choose the care setting that best suits their needs.

•Ensuring Coverage and Reimbursement for Telehealth – Telehealth played an indispensable role in providing quality care to those in need during the COVID-19 pandemic. To build on what has been learned during the crisis, the governor's proposal will:

√ Require commercial health insurers to offer a telehealth program to members, and provide Medicaid coverage, subject to federal approval, to cover services furnished telephonically when medically appropriate;

√ Ensure telehealth is reimbursed at rates that incentivize use when medically appropriate; and

√ Require providers to disclose to patients in writing or through their websites whether they provide telehealth services.

√ Require insurers to provide up-to-date information in their provider directories about which providers offer telehealth services. Any telehealth platforms offered as part of a mandatory telehealth program will be required to participate in the Statewide Health Information Network for New York or otherwise demonstrate interoperability with other providers in the insurer's provider network.

•Expanding the Use of Technological Advancements in Health Care – Cuomo's proposal will also “facilitate the adoption of innovations in technology to ensure higher quality and more efficient care for patients” by:

√ Requiring insurers to offer members an e-triage or virtual emergency department platform that enables individuals to receive a symptoms assessment and a referral to a network of providers or a nearby emergency department when warranted, allowing New Yorkers, particularly in underserved areas that lack health infrastructure, to receive better and faster care in times of emergency;

√ Facilitating the use of expert consultations between providers via telehealth by encouraging insurers to reimburse providers directly for engaging in e-consults or permitting the inclusion of insurers' costs associated with e-consult platforms within the health care service costs. The increased use of e-consults will empower primary care providers to make accurate treatment decisions and help patients avoid unnecessary and costly care; and

√ Streamlining the SHIN-NY patient consent process to increase interoperability and record access amongst health care providers.

•Supporting Patients and Providers Through Professional Development, Education and Innovative Support Programs – While regulatory flexibilities have increased access to services for many New Yorkers, telehealth is new for many and “education and outreach is needed to help get people comfortable connecting with a provider from their home, while providers are also learning how to most effectively use this technology. With the support of the Reimagine New York Commission and the Department of Health, two initiatives are already underway to ensure the successful adoption of telehealth by patients and providers”:

√ Launch of a new telehealth training program created with the leadership of the Reimagine New York Commission in partnership with SUNY Stony Brook and the Northeast Telehealth Resource Center, and with support from Weill Cornell Medicine, Cityblock Health and additional advisors. “Designing an open access, continuing professional education curriculum on telehealth will help providers deliver higher-quality care – especially as technologies continue to develop as New York state is paving the way on these tools”; and

√ Pilot of an innovative telehealth facilitator program conducted by AlRnyc and Mt. Sinai Health Partners, under the guidance of Schmidt Futures and the Reimagine New York Commission. The program aims to improve comfort with and access to telehealth tools for underserved populations, including through hands-on support for the intake and onboarding process. “Patient discomfort with and lack of access to technology is a deterrent and this program will help inform how New York can best assist people in learning to use telehealth and lay the groundwork for future expansion.”

Co-Founder of Schmidt Futures and Chair of the Reimagine New York Commissioner Eric Schmidt said, "Promoting telehealth is a clear example of how New York can build back better. The pandemic opened New Yorkers' eyes to the efficacy and convenience of remote care. The commission is putting forward recommendations to not only solidify the telehealth expansions that many New Yorkers have benefitted from in the last year, but also to go one step further to build a future in which telehealth can benefit us all. This comprehensive overhaul of telehealth policies, in addition to a series of innovative new programs, will ensure every New Yorker, regardless of circumstances, has the support and resources they need to gain access to physical and mental health care."

Chief Health Officer of Cityblock Health and Co-Chair of the Reimagine New York Commission Telehealth Working Group Dr. Toyin Ajayi said, "Even before the COVID-19 pandemic, telehealth showed the potential to expand access to high-quality health care to traditionally underserved communities. And since the beginning of the pandemic, millions of New Yorkers have experienced firsthand telehealth's ability to deliver quality and convenient care. As we build back better, we have an opportunity to ensure that all New Yorkers are empowered to participate in telehealth. Doing so will bring us one step closer to ensuring all New Yorkers have access to the healthcare they deserve."

President of Cornell University and Co-Chair of the Reimagine New York Commission Telehealth Working Group Martha Pollack said, "Throughout the pandemic, use of telehealth by New Yorkers soared and patients and physicians alike saw proof of its power. We can unlock the potential of telehealth going forward by changing the ways in which New Yorkers access health care. This starts with comprehensive policy changes that give providers and patients greater flexibility to use telehealth as they deem appropriate. And we can and must ensure that those New Yorkers who are most in need have greater access to care, through new investments in telehealth infrastructure, and through the creative integration of telehealth technologies with the kinds of human support that cannot be replaced."

Proposal to Modernize Office of Professional Medical Conduct

Cuomo today announced a proposal to modernize the Department of Health's Office of Professional Medical Conduct through a set of comprehensive reforms. The governor will introduce legislation to ensure the office has adequate tools for the effective investigation and discipline of state-licensed physicians, physician assistants, and specialist assistants. Access to up-to-date information about professional license status and investigations will increase public safety and strengthen transparency between the medical community and their patients. Cuomo will also enact renewal requirements for licensed medical professions to streamline oversight.

"Now more than ever, New Yorkers must have the highest confidence and trust in their health care providers," he said. "The health care community has been nothing short of heroic in their work to protect us from the threat of COVID, yet we have unfortunately continued to see certain instances of unscrupulous behavior. By implementing these common-sense reforms, we're not only strengthening penalties against bad actors, but we're improving the ability of investigators to root them out."

The governor will introduce legislation to update the public health law to strengthen disciplinary actions for misconduct resulting in better misconduct enforcement and increased patient safety. In addition, he will propose reforms to the investigation and hearing processes to ensure the office can act swiftly to hold physicians accountable, confirm investigations, and keep patients safe.

Secondly, the governor will propose specific renewal requirements to maintain state licensure to practice. Currently, physicians licensed in New York remain licensed for life, even if they move out-of-state. Enacting renewal requirements “will reduce the number of resources the state devotes to investigating bad actors who have not resided or practiced in New York in some time, but still hold an active state license.”

This proposal builds on Cuomo's continued work to ensure the health and safety of all New Yorkers. In 2018, he signed legislation to allow the Department of Health to suspend the license of any physician charged with a felony, if it were deemed their continued licensure posed a risk to the health of the people of New York. “While the change allowed the Department of Health to act more quickly to protect patients, the current law prohibits public confirmation of an investigation, which has historically left the public with limited information.

“The legislation will bolster transparency by ensuring public access to up-to-date information on all state-licensed professionals and ongoing investigations when appropriate. A targeted effort will also be made to provide the public with information and resources should they be concerned about the professional conduct of a health care provider.”

Proposal to Provide New York Nurses Priority Access to SUNY & CUNY Programs

Cuomo announced legislation to provide New York nurses priority access to SUNY and CUNY programs. Under this proposal, licensed nurses and nursing candidates will receive priority admission to all SUNY and CUNY programs across the state beginning in the fall of 2021 to fulfill baccalaureate credentials and continue practicing.

"Health care workers showed up every day to help keep us safe. They worked tirelessly to save thousands of lives, all while putting their own lives at risk. When I asked them to step up, they did so blindly. They knew the risks and they still came to work every day to protect the rest of us. Many put their lives on hold to help,” Cuomo said. "They had our back, now we must have theirs. We're giving these COVID heroes priority to the greatest university system in the world, to complete their degrees and continue to do what they have done best throughout this pandemic: Keep us all safe."

“BSN in 10” was signed into law by Cuomo in 2017 to enhance the quality of patient care and elevate the nursing profession. It requires all nurses who complete an associate degree in New York state to complete a Baccalaureate of Science degree in nursing within 10 years of becoming a nurse to maintain licensure by the state. SUNY and CUNY will work with campuses to implement priority access for eligible candidates allowing the priority access to SUNY and CUNY nursing programs, which will allow the 40,000 nurses and nursing candidates who are required by law to complete their baccalaureate credentials access to quality and affordable education within the state.

SUNY Chancellor Jim Malatras said, "Within the darkest moments caused by this pandemic, our health care professionals have been an inspiration to us all for their heroic and selfless efforts as they provide life-saving care. This is especially true of our nurses who are the heartbeat of health care. Gov. Cuomo's proposal to provide priority access for New York's licensed nurses is exactly what we need to strengthen and protect our health care system. SUNY stands ready to meet the governor's challenge."

CUNY Chancellor Félix Matos Rodríguez said, "We all owe a debt of gratitude to the selfless health care workers who, throughout this terrifying pandemic, have saved the lives of countless of our family members, friends and neighbors while courageously risking their own. The nurses on the frontlines have been nothing short of heroic in the fight against the deadly COVID-19 virus. Gov. Cuomo's proposal will enable these brave professionals to complete their studies at first-class institutions and continue their life-saving work."

The State University of New York is the largest comprehensive system of higher education in the U.S., and more than 95% of all New Yorkers live within 30 miles of any one of SUNY's 64 colleges and universities. Across the system, SUNY has four academic health centers, five hospitals, four medical schools, two dental schools, the state's only college of optometry, and manages one U.S. Department of Energy National Laboratory. As of fall 2019, more than 415,500 students were enrolled in a degree-granting program at a SUNY campus. In total, SUNY serves about 1.3 million students in credit-bearing courses and programs, continuing education, and community outreach programs. SUNY oversees nearly a quarter of academic research in New York.

The City University of New York is the nation's largest urban public university. Founded in 1847 as the nation's first free public institution of higher education, CUNY today has seven community colleges, 11 senior colleges and seven graduate or professional institutions spread across New York City's five boroughs, serving 500,000 students of all ages and awarding 55,000 degrees each year.

Proposal to Prohibit Utility Disconnections During Emergencies

The governor announced a proposal to prohibit utility disconnections in regions that are under a state of emergency. He will propose legislation that will apply to electric, gas, water, telecommunications, cable and internet services. Utilities that fail to comply will be subject to penalties.

"In a year in which we dealt with an unprecedented pandemic, ferocious storms added insult to injury by knocking out power for hundreds of thousands of New Yorkers," Cuomo said. "Utility companies provide essential services, and we need to make sure they continue to provide them, rain or shine. That's why we're proposing legislation to make sure that New Yorkers, especially those living in regions under states of emergency, have access to these critical services to provide for themselves and their families."

Cuomo has taken a series of actions to protect New Yorkers' access to utilities during the COVID-19 pandemic. Last year, he signed legislation extending a moratorium that prevents utility companies from disconnecting utilities to residential households that are struggling with their bills due to the COVID-19 pandemic. Utility companies must, instead, offer these individuals a deferred payment agreement on any past-due balance.

On Nov. 19, the governor announced Con Edison faces $25 million in penalties and possible license revocation from the New York State Public Service Commission following an investigation into the utility's alleged “failed response” during large-scale power outages in Manhattan and Brooklyn in July 2019.

On Nov. 2, Cuomo announced more than $328 million in home heating aid is now available for low- and middle-income New Yorkers who need assistance keeping their homes warm during the coming winter season.

A press release concluded, “The governor has previously enacted some of the strongest and most progressive consumer protection and assistance programs in the country. Gov. Cuomo established New York's energy affordability policy in 2016. The policy extended energy bill support to more than 152,000 additional New York families, ensuring that more than 920,000 New York families spend no more than 6% of their income on energy bills. Through this program, New York commits more than $238 million annually helping to keep the lights and heat on for our most vulnerable New Yorkers, while actively striving to expand coverage to additional families.”

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