On November 18th, the New York State Department of Health (DOH) hosted an informational webinar on the State’s approach to the future extension of and amendments to the 1115 Medicaid Redesign Team (MRT) Waiver, which governs most of New York’s Medicaid program, including its managed care authorities. Currently, the MRT Waiver is set to expire on March 31, 2021.
In November 2019, the State submitted a waiver renewal request (available here), which included a 4-year extension of the Delivery System Reform Incentive Payment (DSRIP) program, to the Centers for Medicare and Medicaid Services (CMS). This request was declined by CMS in February 2020. In May 2020, the State submitted an emergency administrative extension request (available here) to support urgent systemic needs revealed by the COVID-19 pandemic. CMS also denied this request, stating that New York will need to complete a formal renewal process.
As a result, the State is finalizing a proposal that will formally extend the core MRT Waiver authorities without proposing major new reform initiatives, other than certain initiatives proposed by the second Medicaid Redesign Team (MRT II). Specifically, the proposal includes:
- A three-year extension of the existing special terms and conditions and funding authorities under the current MRT 1115 Waiver, including Medicaid managed care (MMC), Managed Long Term Care (MLTC), Health and Recovery Plans (HARP), and Children’s Home and Community Based Services (HCBS);
- The transition of the pharmacy benefit from MMC to fee-for-service (i.e., the “Pharmacy Carveout”); and
- The transition of the transportation benefit from MLTC plans to fee-for-service (i.e., the “Transportation Carveout”).
Other programmatic changes will not be included in this submission. If and when this request is approved by CMS, the State will then submit future amendments that pursue further transformation goals requiring 1115 Waiver authority. These may include amendments focused on:
- Value-based payments;
- Global budget initiatives;
- Investments in telehealth following the impact of COVID-19;
- Workforce reinvestment;
- Criminal justice reform; and
- Other long-term policy goals that align with the initiatives included in previous proposals and the priorities of the Biden Administration.
This strategy is consistent with the development of the DSRIP program and HARP, which were implemented as programmatic amendments after the underlying waiver was extended. Additionally, this submission will allow pending and anticipated 1115 Waiver amendments from the MRT II process, such as HCBS Behavioral Health Optimization and Duals Integration, to be reviewed and approved consistent with current implementation targets.
The State’s presentation can be found here. The 1115 Waiver Extension Request will be posted on the 1115 Waiver information page here. Public comment will be accepted for 30 days starting on December 16th. The State will host virtual public hearings on January 21, 2021 and January 27, 2021 from 1pm-4pm. The State’s target submission of the proposal to CMS is early March 2021, after the transition in federal administration.
Questions may be submitted to 1115waivers@health.ny.gov.