Governor Cuomo Announces New Waiver Addressing Critical Issues in New York State Health Care System through DSRIP Program

by Proskauer Rose LLP
Contact

On April 14, 2014, Governor Andrew Cuomo announced that New York has finalized terms and conditions with the federal government for a waiver that will allow the state to reinvest the $8 billion in federal savings from the Medicaid Redesign team reforms.

The waiver amendment dollars will address critical issues throughout the state and allow for comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program will promote community-level collaborations and focus on system reform, with the goal to reduce avoidable hospital use by 25 percent over five years.

The $8 Billion reinvestment will be allocated in the following ways:

  • $500 Million for the Interim Access Assurance Fund—temporary, time limited funding to ensure current trusted and viable Medicaid safety net providers can fully participate in the DSRIP transformation without disruption. This will be split evenly between public and non-public hospitals. The state will make all decisions regarding eligibility and distribution and of grants which are limited to providers serving significant numbers of Medicaid members.

  • $6.42 Billion for DSRIP—including grants, provider incentive payments, and administrative cost reimbursement.

  • 1.08 Billion for other Medicaid Redesign purposes—supporting Health Home development, investments in long term care, workforce and enhanced behavioral health services.

A hospital must meet one of the three following criteria to participate in DSRIP as a Performing Provider System (PPS):

    (1) must be a public hospital, Critical Access Hospital, or Sole Community Hospital; or

    (2) must pass two tests:

(a) at least 35 percent of all patient volume in their outpatient lines of business must be associated with Medicaid, uninsured, or Dual Eligible individuals; and

(b) at least 30 percent of inpatient treatment must be associated with Medicaid, uninsured, and Dual Eligible individuals; or

    (3) must serve at least 30 percent of all Medicaid, uninsured, and Dual Eligible individual members in the proposed county or multi-county community.

Non-hospital based providers, not participating as part of a state-designated Health Home, must have at least 35 percent of all patient volume in their primary lines of business and must be associated with Medicaid, uninsured, and Dual Eligible individuals. The state will consider exceptions to the above qualifications if it is deemed in the best interest of Medicaid members. The reasons for granting such an exception include: (1) a community will not be served without granting the exception because there are no other eligible providers in the community; (2) hospital is uniquely qualified to serve based on services provided, financial viability, relationships within the community, and/or clear track record of success in reducing avoidable hospital use; and (3) any state-designated Health Home or group of Health Homes.

A PPS will be able to apply for funding from one of two DSRIP pools: Public Hospital Transformation Fund, which is open to applicants led by a major public hospital system, and Safety Net Performance Provider System Transformation Fund, which is open to all other DSRIP eligible providers. The allocation of funds between the two pools will be determined after applications have been submitted.

DOH expects to receive nonbinding letters of intent from potential applicants by May 15, and June 15 is the deadline to apply for a planning grant, which will fund organizations' community assessments and research for the actual proposal application. DSRIP project proposals will be due in December 2014. The project proposals must create a new initiative for the PPS which is substantially different from all other initiatives funded by CMS, although it may build on or augment such an initiative. The plan must address one or more significant issues within the PPS service area and be based on a detailed analysis using objective data sources. Additionally, it must be a substantial, transformative change for the PPS and demonstrative of a commitment to life-cycle change and a willingness to commit sufficient organizational resources to ensuring project success. The plan must be developed, in concert, with other providers in the service area, with special attention paid to coordination with Health Homes actively working in the area.

There are four domains, and three of them (Domains 2 through 4) must be addressed by the PPS project plans. Domain 1 is overall project progress and includes investments in technology, tools, and human resources that will strengthen the ability of the PPS to serve target populations and pursue DSRIP project goals. Domain 2 is system transformation and projects will focus on creating integrated delivery systems and implementing care coordination and transitional care programs. Domain 3 is clinical improvement for certain priority disease categories. Domain 4 is population-wide strategy implementation, which is aligned with the NYS Prevention Agenda.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Proskauer Rose LLP | Attorney Advertising

Written by:

Proskauer Rose LLP
Contact
more
less

Proskauer Rose LLP on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.